The 2012 election campaign is in full swing, and, for better or worse, health care is one of the major defining issues of the election. How can it not be, given the passage of the Patient Protection and Affordable Care Act (PPACA), also colloquially known as “Obamacare,” was one of the Obama administration’s major accomplishments and arguably the largest remaking of the American health care system since Medicare in 1965? It’s also been singularly unpopular thus far, contributing to the Republican takeover of the House of Representatives in the 2010 elections, as well as the erosion of Democratic control of the Senate. Whatever the true benefits, costs, and drawbacks of “Obamacare,” there have been sum unbelievably stupid things said about it, and I’ve even documented some of them by opponents of the PPACA, including the claim that Obama’s fixin’ death panels for grandma. Amusingly, the “Health Ranger” (a.k.a. Health Danger) Mike Adams really hates Obamacare, to the point of proclaiming shortly after it was passed into law that the PPACA would produce a health care dictatorship and doom America to Pharma-dominated sickness and suffering. He even called it a “crime against America.”

Unfortunately, laying out enough napalm-grade flaming stupid to defoliate the entire Amazon River basin is not limited to clueless wonders like Mike Adams. There are other clueless wonders out there who don’t seem to understand the real world. Unfortunately, one of them is running for President. Yes, I’m referring to Mitt Romney, who late last week made a statement so brain-meltingly out of touch with the real world that even I had a hard time believing that he actually said it. Ironically, enough, a mere couple of days after Mitt Romney put his cluelessness on display for the world to see, there also appeared a tear-inducing op-ed piece published yesterday in the New York Times by Nicholas Kristof entitled A Possibly Fatal Mistake, which described in a very personal story about a friend of his the health impact of not having health insurance for those millions of people.

As politically charged an issue as whether the government should provide universal health care for its citizens and how much we as a society should be willing to pay for it is (at least in this country; it doesn’t seem to be particularly controversial in most other developed countries, particularly those in Europe), the relationship between health insurance and, well, health is a question that can be addressed scientifically, which puts it right smack dab within the purview of science-based medicine. What to do about it, in contrast, is a matter for politics and public policy. Think about it in much the same way as anthropogenic global warming. Science tells us that it is happening and suggests strategies to mitigate it. Which of these strategies we choose is a matter of politics and policy.

So first let’s examine the question.

The clueless versus the human

Before we discuss the evidence regarding the health effects of being uninsured, let’s look Romney’s statement and why it resulted in so much blowback. Romney made his assertion during an interview with the editors of The Columbus Dispatch:

“We don’t have a setting across this country where if you don’t have insurance, we just say to you, ‘Tough luck, you’re going to die when you have your heart attack,'” he said as he offered more hints as to what he would put in place of “Obamacare,” which he has pledged to repeal.

“No, you go to the hospital, you get treated, you get care, and it’s paid for, either by charity, the government or by the hospital. We don’t have people that become ill, who die in their apartment because they don’t have insurance.”

He pointed out that federal law requires hospitals to treat those without health insurance — although hospital officials frequently say that drives up health-care costs.

Romney was referring to the Emergency Medical Treatment and Active Labor Act (EMTALA), a federal law passed in 1986 under the Reagan administration that requires hospitals to provide care to anyone needing emergency treatment regardless of citizenship, legal status, or ability to pay. Hospitals may only transfer or discharge patients requiring emergency care after stabilization, when their condition requires transfer to a tertiary care hospital, or against medical advice. It is highly unlikely that any person who has ever worked in an emergency room or cared for the uninsured would make such a statement. Emergency rooms are not equipped to treat complex conditions; all they can do is to treat the acute problem. In addition, tertiary care hospitals receive a lot of patients admitted under EMTALA, who are transferred at the drop of a hat. Well do I remember my days as a surgery resident rotating in the county hospital, when we used to joke about the routine near-inevitable Friday afternoon phone calls from private hospitals asking to transfer patients who had failed a wallet biopsy. We even knew what time was the “witching hour,” when we were most likely to get such calls. Of course, the problem with EMTALA was (and is) that there were no provisions for reimbursement for uncompensated care. Basically, hospitals were (and, for the most part, still are) forced by law to eat the costs of caring for the uninsured. It’s an incredibly inefficient and irrational system. Yes, it does make sure that most people can get at least emergency care, but it makes no provisions for any treatment for long term care that can’t be provided in emergency rooms or as inpatients.

Since completing fellowship, I have held faculty positions in two of the 41 NCI-designated comprehensive cancer centers in the U.S., both of which take care of a lot of uninsured patients. I’ve seen more women than I can remember who waited far longer than they should have to see a doctor for their breast cancer because they couldn’t afford to see a doctor or were afraid of how much it would cost even to do a biopsy. Over the years, all too often my patients have been symptomatic for quite some time, and when they finally do present their tumors are larger, more difficult to treat, and more likely to kill them. They represent the female equivalent of Kristof’s uninsured friend Scott, who is the human face of the issue discussed in his NYT op-ed and tells his story:

In 2011 I began having greater difficulty peeing. I didn’t go see the doctor because that would have been several hundred dollars out of pocket — just enough disincentive to get me to make a bad decision.

Early this year, I began seeing blood in my urine, and then I got scared. I Googled “blood in urine” and turned up several possible explanations. I remember sitting at my computer and thinking, “Well, I can afford the cost of an infection, but cancer would probably bust my bank and take everything in my I.R.A. So I’m just going to bet on this being an infection.”

I was extremely busy at work since it was peak tax season, so I figured I’d go after April 15. Then I developed a 102-degree fever and went to one of those urgent care clinics in a strip mall. (I didn’t have a regular physician and hadn’t been getting annual physicals.)

The doctor there gave me a diagnosis of prostate infection and prescribed antibiotics. That seemed to help, but by April 15 it seemed to be getting worse again. On May 3 I saw a urologist, and he drew blood for tests, but the results weren’t back yet that weekend when my health degenerated rapidly.

A friend took me to the Swedish Medical Center Emergency Room near my home. Doctors ran blood labs immediately. A normal P.S.A. test for prostate cancer is below 4, and mine was 1,100. They also did a CT scan, which turned up possible signs of cancerous bone lesions. Prostate cancer likes to spread to bones.

I also had a blood disorder called disseminated intravascular coagulation, which is sometimes brought on by prostate cancer. It basically causes you to destroy your own blood cells, and it’s abbreviated as D.I.C. Medical students joke that it stands for “death is close.”

I realize that right now I’m referring to my anecdotal experience. However, one anecdote is that of a man who gambled and lost because health insurance was too expensive. The rest is my experience in a highly specialized field in a city with high unemployment and poverty. It is quite possible that such experience can be misleading, and certainly one of the key messages we promote on this blog is that anecdotal experience is inherently potentially misleading. (That’s why it’s the primary evidence used by promoters of unscientific or pseudoscientific medicine.) In a way, Kristof’s friend’s story would seem to confirm Romney’s statement, at least on the surface. Scott did, after all, end up getting excellent medical care for his stage IV prostate cancer, and, although he probably could have afforded health insurance if he had stretched a bit, did make a choice not to purchase insurance. But, then, as I said, anecdotes can be misleading.

The evidence

Before we get into the data itself, it is not much of a stretch to imagine that not having health insurance would result in worse health outcomes. What I am trying to say using “science-based medicine-speak” is that the hypothesis that people without health insurance will be more likely to have health problems and die unnecessarily than people who have decent health insurance is a hypothesis with a fairly high degree of what we in the SBM biz refer to as prior plausibility. After all, if you’re uninsured, you’re less likely to see a physician except when you get sick, less likely to be able to pay for your medications (particularly if they are expensive), and less likely to undergo routine preventative care. It’s thus plausible that being uninsured would be associated with an increased risk of death or poor health outcomes. None of this means we don’t have to do the research and look at the evidence; all it does is to suggest hypotheses to test and emphasize that these hypotheses have a reasonable chance of being consistent with the data. Also, this question is difficult to study because of all the potential confounders. After all, not having health insurance is associated with a lot of things that could be contributing to mortality, such as lower socioeconomic status, substance abuse, and the like.

Even twenty years ago, this question was of intense interest. One of the seminal studies examining the relationship between health insurance and health outcomes was published in JAMA by Franks et al., who prospectively followed 4,694 adults older than 25 years who reported they were uninsured or privately insured in the first National Health and Nutrition Examination Survey (NHANES I), a representative cohort of the US population from initial interview in 1971 through 1975 until 1987. They found a 25% higher risk of mortality in the uninsured after adjusting for age, smoking, alcohol consumption, obesity, education and income. This effect was evident in all sociodemographic health insurance and mortality groups examined.

In 2002, the Institute of Medicine estimated that over 18,000 Americans between the ages of 25-64 die annually because of lack of health insurance, a number comparable to the number who died of diabetes, stroke, or homicide in 2001. Among the conclusions of this report:

Uninsured adults are less likely than adults with any kind of health coverage to receive preventive and screening services and to receive them on a timely basis. Health insurance that provides coverage of preventive and screening services is likely to result in greater and more appropriate use of these services.

Uninsured cancer patients generally are in poorer health and are more likely to die prematurely than persons with insurance, largely because of delayed diagnosis. This finding is supported by population-based studies of persons with breast, cervical, colorectal, and prostate cancer and melanoma.

Uninsured adults with diabetes are less likely to receive recommended services. Lacking health insurance for longer periods increases the risk of inadequate care for this condition and can lead to uncontrolled blood sugar levels, which, over time, put diabetics at risk for additional chronic disease and disability.

Uninsured adults with hypertension or high blood cholesterol have diminished access to care, are less likely to be screened, are less likely to take prescription medication if diagnosed, and experience worse health outcomes.

Uninsured patients with end-stage renal disease begin dialysis with more severe disease than do those who had insurance before beginning dialysis.

Uninsured adults with HIV infection are less likely to receive highly effective medications that have been shown to improve survival and die sooner than those with coverage.

Uninsured patients who are hospitalized for a range of conditions are more likely to die in the hospital, to receive fewer services when admitted, and to experience substandard care and resultant injury than are insured patients.

Uninsured persons with trauma are less likely to be admitted to the hospital, more likely to receive fewer services when admitted, and are more likely to die than are insured trauma victims.

Uninsured patients with acute cardiovascular disease are less likely to be admitted to a hospital that performs angiography or revascularization procedures, are less likely to receive these diagnostic and treatment procedures, and are more likely to die in the short term.

In 2008, the Urban Institute updated the IOM numbers by applying the methodology used by the IOM to more recent Census Bureau estimates of the uninsured, and estimated that in 2006 there were 22,000 excess deaths that could be attributed to lack of health insurance. The Urban Institute also suggested that the IOM analysis might have underestimated the number of deaths resulting from being uninsured. Its rationale was as follows:

The underlying longitudinal studies on which IOM relied did not specify the impact of insurance coverage on mortality by 10-year age groups. Rather, they documented the relationship between insurance and mortality across the sum total of all surveyed age groups. The IOM’s methodology implicitly assumed that insurance reduces mortality by the identical percentage for each 10-year age band, which the underlying research did not show. More grounded in the research would be an application of differential mortality estimates to all adults age 25–64, as was done for those longitudinal studies, rather than separately to each age group within this range. For 2000–06, this alternative approach raises the estimated number of excess deaths by an average of 20.5 percent a year.

In 2009, in a study from Harvard Medical School and the Cambridge Health Alliance, Wilper et al. published updated estimate of excess mortality associated with lack of insurance in the American Journal of Public Health. This analysis used methodology similar to that of Franks et al. applied to the third National Health and Nutrition Examination Survey (NHANES III), specifically 9,004 patients between ages 17 and 64 with complete baseline data for interview and physical examination. They found that the hazard ratio for death for the uninsured was 1.40 (confidence interval 1.06 to 1.84) compared to those with private health insurance. This particular study is the source of a rather famous number: 45,000 patients die due to lack of insurance each year. This particular study is at the high end of the estimates of excess deaths associated with lack of health insurance, which is why it not surprisingly often comes in for the most criticism, particularly given that it was supported by a partisan group, Physicians for a National Health Program. That’s why I tend to view this study as an outlier, but even outliers can sometimes tell us something. Whether the Harvard study was an outlier or not, that same year, the IOM updated its 2002 report. One of its conclusions was:

In contrast, the body of evidence on the effects of uninsurance on adults’ health has strengthened considerably since 2002. Numerous studies have addressed some of the methodological shortcomings of past research. As discussed further below, 17 observational and 13 quasi-experimental rigorous analyses have reported significant findings related to health insurance and adults’ health (Table 3-3) (McWilliams, 2008). The quality and consistency of the recent research findings is striking. As would be expected, health insurance is clearly most beneficial for adults who need medical attention, particularly for adults with common chronic conditions or acute conditions for which effective treatments are available. Furthermore, national studies assessing the effects of near-universal Medicare coverage after age 65 suggest that uninsured near-elderly adults who are acutely or chronically ill substantially benefit from gaining health insurance coverage.

But that’s not all. Since it’s my specialty, I’ll pick a recent study published this year examining the outcomes of 2,157 hospital admissions for women with spinal metastases from breast cancer. Analyses were adjusted for differences in patient age, gender, primary tumor histology, socioeconomic status, hospital bed size, and hospital teaching status. The investigators found that women operated on for spinal metastases from breast cancer tended to do worse and have a higher risk of death if they were uninsured than if they had private insurance. The authors concluded that the poorer outcomes observed among the uninsured were primarily due to the uninsured patients being significantly more likely to have a nonelective hospital admission and present with myelopathy. Although this study had some limitations, namely that it couldn’t account for lesser quality private insurance (for instance, plans with high copays and/or poorer coverage) and variations in Medicaid eligibility by state. Also, the database used only includes in-hospital data and therefore couldn’t examine long-term outcomes.

Since surgery is also my specialty, I thought I’d also point out that there is considerable evidence that being uninsured or underinsured is associated with worse outcomes after surgery. For example, a recent study published in the Annals of Surgery from LePar et al. at the University of Virginia examined outcomes from 893,658 major surgical operations and found that mortality was considerably worse in Medicare, Medicaid, and the uninsured than they were in patients with private insurance. Adjusting for age, gender, income, geographic region, operation, and 30 comorbid conditions eliminated the outcome disparity for Medicare patients, but Medicaid and uninsured payer status still independently conferred the highest adjusted risks of mortality.

Not so fast…

Of course, for a question as complex and prone to confounders as whether lack of health insurance is associated with poorer outcomes, including mortality, there are always those who are not convinced by existing observational data. Certainly, lack of health insurance can be a marker, not a cause, for poor health and subsequent poor outcomes, and teasing out the various confounding factors is not a trivial task. Perhaps the most widely cited study questioning this relationship was featured prominently in an oft-cited article in the lay press by Megan McArdle in The Atlantic entitled Myth diagnosis. It’s a study by Richard Kronick published in Health Services Research in 2009 that questions the IOM report from 2002:

These results demonstrate that if two people are otherwise similar at baseline on characteristics controlled for in the model presented in Table 3, but one is insured and the other uninsured, their likelihood of survival over a 2–16-year follow-up period is nearly identical. Further, I show that survival probabilities for the insured and uninsured are similar even among disadvantaged subsets of the population; that there are no differences for long-term uninsured compared with short-term uninsured; that the results are no different when the length of the follow-up period is shortened; and that there are no differences when causes of death are restricted to those causes thought to be amenable to the quality of health care.

Basically, Kronick found no relationships between insurance status and mortality. While this study was large (600,000 subjects) and controlled, it is also an outlier, just as much as the Harvard study is an outlier. Again, that doesn’t mean it was a bad study; outliers can often tell us something, and what Kronick seems to be telling us is that the magnitude of the effect on mortality associated with lack of insurance might not be as large as previously thought. Might. It is, remember, just one study, as large as it might be. McArdle might refer to Kronick’s study as “what may be the largest and most comprehensive analysis yet done of the effect of insurance on mortality,” which sounds incredibly impressive, but the simple fact is that no single study can provide the answer, particularly to question as complex as whether having no health insurance status is associated with increased mortality and poor outcomes. Kronick’s study also has a significant problem that was pointed out in this post by Ezra Klein, namely that people in poor health are more likely to seek health insurance, which would tend to obscure any positive relationship between health insurance and health status.

This result is not, perhaps, as shocking as it seems. Health care heals, but it also kills. Someone who lacked insurance over the past few decades might have missed taking their Lipitor, but also their Vioxx or Fen-Phen. According to one estimate, 80,000 people a year are killed just by “nosocomial infections”—infections that arise as a result of medical treatment. The only truly experimental study on health insurance, a randomized study of almost 4,000 subjects done by Rand and concluded in 1982, found that increasing the generosity of people’s health insurance caused them to use more health care, but made almost no difference in their health status.

I hate to say it, but McArdle is drifting rather close to Gary Null territory here, in which she seems to be arguing that whatever benefit having decent health insurance might convey, it’s about the same as the harm that “conventional” medicine does. In other words, her argument seems to be that providing people more access to health care will cause as much harm as benefit, making it a wash whether one is insured or not. Of course, that argument cuts both ways, if you accept estimates of over 100,000 “deaths by medicine” per year in that it would imply that having health insurance confers a benefit in terms of mortality reduction that is much larger than the numbers we have would suggest, making the imperative to improve health care coverage and decrease medical errors a much more reasonable conclusion from such an argument than concluding that striving for universal coverage would not reduce mortality. Be that as it may, more problematic is that like many proponents of dubious medicine and science, McArdle cherry picked the literature, choosing one study that is an outlier and a thirty year old study from the RAND Corporation that showed what she wanted and in essence dismissed the rest. In refuting McArdle, by J. Michael McWilliams, MD, PhD, Assistant Professor of Health Care Policy and Medicine at Harvard Medical School and an associate physician in the Division of General Medicine at Brigham and Women’s Hospital points this out and speculates:

How many lives would universal coverage save each year? A rigorous body of research tells us the answer is many, probably thousands if not tens of thousands. Short of the perfect study, however, we will never know the exact number.

Indeed.

Policy implications

The very term “science-based medicine” was chosen intentionally. Medicine itself is not a science. It can’t be. There are too many other factors that influence treatments, including patient preference, resource allocation, and level of skill of individual practitioners, to name just a few. Our central thesis is that medicine should be based on science and that the best health care is based on science. My purpose in writing this post was not to advocate for any specific solution to the problem of the uninsured, although people who know me know my politics and my position on the matter. Rather, it is to lay out the science studying the question of the relationship between health insurance status and health outcomes. While we do frequently say that correlation does not necessarily equal causation, in some cases the correlation is so tight that it strongly suggests causation. This is one such case. Given that there is no ethical way ever to do a randomized clinical trial in which people are randomly assigned to be insured or uninsured, much as is the case for examining health outcomes between vaccinated and unvaccinated children, we are forced to rely on observational and quasi-experimental data. Those data support the hypothesis that providing health insurance to as many people as possible is associated with better health outcomes and that lack of insurance is associated with poorer health outcomes. That is the science. When someone like Mitt Romney claims that no one ever dies from lack of insurance in the U.S., he is demonstrably mistaken, and, in fact, his even saying such a thing so confidently is strong evidence that he does not know what he is talking about.

What we as a society decide do with the results of the science examining this question is less a matter of science than it is of politics and policy.

While Romney’s statement is certainly out of touch (limiting itself to acute care only), recall that during his term as governor Massachusetts enacted its own universal health care law. Presumably he does see the benefit of reducing financial disincentives to getting ongoing care and early diagnosis, but chose not to mention that in this particular sound bite.

As one of them libruls, I had hoped that underneath all the hard-right bluster needed to secure the Republican nomination, Romney might at least be a competent technocrat. Those hopes appear to have been ill-founded.

Hopefully this won’t end up like the comment section on your friend’s healthcare post!

I’m a filthy socialist from Britain, so my brain is boggled by a “developed” country that institutes fees for being born, then continues billing until the last breath.

Mittens is either deluded or a liar. Not sure which is worse. I have… I had American friends who’ve died due to lack of money. 21st century USA. A place where needing oxygen has to be weighed up against needing to pay rent.

That was a different Mitt, mindy. The one that was for stem cell research, that one that said “I believe that abortion should be safe and legal in this country. I believe that since Roe v. Wade has been the law for 20 years, that we should sustain and support it. I sustain and support that law and the right of a woman to make that choice.”

The one that stated in a letter to the Log Cabin Republicans he was in favor of “gays and lesbians being able to serve openly and honestly” in the military.

The one that said “I’m proud of what we’ve done. If Massachusetts succeeds in implementing [Romneycare], then that will be a model for the nation.”

Clearly it’s some other Mitt Romney running for president–version 2.0.

The one that said “I’m proud of what we’ve done. If Massachusetts succeeds in implementing [Romneycare], then that will be a model for the nation.”

I can’t understand why the Obama campaign does not constantly reference this. Are they afraid to say, “We implemented Mitt Romney’s healthcare plan” because they think Romney will embrace it as a selling point?

“See, it was OUR idea, and the president just borrowed it. Vote for us, because we are the ones with ideas! The president also followed through on my idea to bail out the US automakers. These are all MY ideas, not his!”

Clearly Mitt is lying for political points. That puts him in a very large majority group of politicos. Its his lack of math skills that worry my more. Using the emergency room for primary care has huge negative liabilities.
$$$ Requires hospitals to employ more staff.
$$$ Requires patients to wait for care making them sicker and causing them to miss work.
$$$ Requires hospitals to eat costs and raise fees for insured patients. $5 aspirin, etc.
$$$ As Orac notes, lack of insurance delays action by many causing treatable conditions to be less so and at far greater cost.

Anecdote alert: On a Sunday one June, I got fever and chills and a red line appeared on my leg next day. The internet said go to emergency NOW. Wife drove me over on a Monday evening and I waited 6+ hours before I was through triage and began receiving treatment. Meanwhile the red line had moved north many inches. And I HAD insurance.
Cellulitis was diagnosed next day and I spent 3 more days in a hospital bed on intravenous antibiotics watching the line retreat and fade. The crowd of sick folks in emergency delayed my treatment and caused me to spend more time (according to the doctor) in hospital. Had I been seen quicker, I might not have needed to even be admitted. A huge cost my insurance picked up that raises their costs and eventually, my and everyone else’s copays.

“So Mitt, if it doesn’t matter whether anyone has insuance, why did you create a policy in Mass where people were required to buy insurance or pay a penalty?”

Easy. Because it scored the political brownie points it needed to. He correctly deduced that a majority of voters in that state favored such a health care plan. His policies are *solely* built around what he thinks will best advance his political career.

Glad you wrote this. As a Canadian I find it hard to swallow the way things are done in the U.S.- one of the highest infant mortality figures in the world, not a great life expectancy compared to other countries and probably all too many “Scotts.” We spent (Canada in 2009) our lowest amount of health costs on docs (relative to hospitals and pharmaceuticals). Perhaps docs could take less money there? (I know there are lawsuit problems). Hospitals could be less hotel-like? Talking to some friends from Texas I was kind of sickened by their choices when shopping for hospitals to give birth at. Jesus, I mean women have been giving birth for eons and we don’t really need fountains and 5-star hospitals that look like hotels.
I will admit a few friends have gone over to the US for angioplasty re. their MS. The private system does encourage innovation. They did find a lot of improvement -not placebo presumably since improved eyesight can’t be faked- but one re-stenosed so obviously the corrections seem to be short-lived for some and the problem needs more study.
Interesting parallel between studying insured/non-insured and vacc non-vaccinated. I think in light of your country having one of the highest infant mortality rates and the most aggressive infant vaccine schedule at least more animal model studies need to be done to compare safety (or tease out the variables in studies of the many who have already opted to not vaccinate).

Erving Goffmman wrote that people present themselves to the public one way and perhaps are privately quite a different person ( later on, he wondered if there was anything at all beneath the surface) So is there any *there* there, Mr Mitt?

This creature seems to have been outed through a spy video of his interaction with wealthy donors, next he speaks conservatively to socially and economically conservative partisans and later on, more moderately to a wider audience. Maybe he does Janus one better.

From what I’ve seen, I think he’s all about money and he stiffly manoeuvres himself around that fact by continuously talking about how charitable he is and how much he cares for his country . For a supposedly adroit businessman, he seems to have trouble with mathematics and communication. And I’ve seen logs with more empathy.

But here is the killer for me: the reliance upon trickle-down and de-regulation to stimulate a flagging economy- maybe he’d mimic the creative stylings of Mssrs Reagan or Bush; recently PM David Cameron brilliantly argued that governmental cutbacks were appropriate in an economic downturn. I’m sure that will work out really well.

So like elburto, I’m a socialist too. And a Keynesian. If you keep cutting taxes for wealthy people, there’s no guarantee that they will create jobs or even keep the money in the national economy- they can put it aside or invest overseas.

The guy basically wants lower taxes to augment his own wealth although he doesn’t pay high tax rates to begin with: he is supported by extremely wealthy people and might not have an inkling of how the other half lives. I think that wealthy people are not doomed to being clueless about the less fortunate but in his case, I don’t know whether it’s a choice or reflects a disability. Young children attribute poverty and wealth to personal characteristics, as they get older they tend to implicate more environmental and social causes. Not everyone gets more liberal in this way apparently.

jen — I realize you have a particular axe to grind against vaccines, but please, even if you were right, you would be addressing an anthill while a mountain stands next to it. Same with stents; I agree the science behind those is still a bit murky, but that’s not the main problem here. The main problem in the US has nothing to do with the quality of care or the vaccine schedule or any of that — it’s to do with the appalling reality that a huge percentage of Americans have little to no access to the excellent health care that we have here. We’ve got MRIs in strip malls, for goodness sakes. But all that means precisely squat if you don’t have a way to pay for it.

Babies die, mothers die, young people die, old people die, needlessly and in far too much pain, all because they are in a position of choosing between health care and rent or food or utilities. Each state sets a limit on the maximum income a person can receive and still qualify for assistance; in the state of Mississippi, it’s so low that if you make any money at all, you will pretty much not qualify. And even if you do qualify, the system doesn’t cover much. Prenatal care? Nope; very few states provide any sort of assistance for that — and those that do, it’s usually just Planned Parenthood, which is now under assault in the name of preventing abortions, without any proposals to replace this vital service to expectant mothers. The teen pregnancy rate is a factor as well, of course; babies born to teen mothers are much less likely to survive long because they are more likely to have problems.

I have health insurance. My babies had regular checkups until they’d regained their birthweight, and then after that they had periodic checkups during the first year, then bi-annual checkups, then annual. If there had been failure to thrive, it would have been noted and dealt with. But if I didn’t have health insurance, would I have taken them in for all those checkups? At $130 a pop, that’s doubtful. Anything causing failure to thrive would likely be addressed not via a regular checkup but in the emergency room, when the child’s health finally crashed and there would be much less that could be done about it.

So whether stents or vaccines are worthwhile is really not the main problem in this particular debate. There are far too many Americans who would like to have to worry about which vaccines to take or whether or not to get a stent, because it would mean they had some sort of choice in the matter. As it stands, for the most part the only choice they have is to skip them all, because otherwise they’ll go bankrupt. Wait a bit longer on that stent; maybe it’ll clear up without it, and then you’ll be able to afford to buy the kids new school clothes this year, that actually fit and don’t have patches on the patches. People argue about whether or not various breast cancer treatments are effective, while far too many women are crossing their fingers and hoping so they don’t have to fork over three months rent to pay for testing. We need to keep studying the effectiveness of all interventions, but we also need to address this serious problem that for too many people, it doesn’t even matter since they can’t afford it anyway.

As our most esteemed and gracious host observes, alt media thinks that less access to SBM might actually be healthy.

There’s no cloud obscuring this silver lining**, I catch a glimpse of them rubbing their greedy, little hands together because if people are too poor for SBM perhaps they are primed for *health care* ( instead of *sickcare*, i.e. SBM) provided by THEM.

If you check out Adams’, Null’s or Mercola’s stores at their websites: so many of the products offered are “immune- enhancing” or meant to be used as stopgap preventive medicine : Adams’ new store ( @ Natural News) includes a preparedness section with herbal ‘medicine cabinets’ of varying sizes to address any health problems you might encounter: obviously you don’t have to save them for total societal collapse.

Calli, I totally agree with you. I was just pointing out that the private system does encourage some innovation. Also with respect to vaccines I just brought it up since Orac had an interesting parallel between studying insured/uninsured.
I cannot for the life of me understand how Mitt can say the things he does with a straight face. I also just don’t get how they square it (not being for universal care) with their religious beliefs. I’m pretty sure (and I consider myself to believe in God but not be super-religious) Jesus would stand for universal healthcare. It is worth fighting for.

Mark Hoofnagle at denialism has a series of posts examining the health care systems of various wealthy countries, including the US.

The other countries reviewed have systems ranging from actually socialist, such as the UK’s NHS, to regulated but privately-run, such as the Netherlands’, which if memory serves most closely resembles what PPACA could lead to.

Since on average almost every other wealthy country spends approximately half what the US does on health care, and gets comparable health outcomes, it seems to me that the US could certainly change its present system without compromising on what certainly is high-standard care (when you can afford it).

If insurance doesn’t matter to outcomes, then Mittens should have Ann drop all insurance coverage. And the horsie, too.

Might be tough on Ann, but I gotta say — with one friend who can’t afford an electronic wheelchair (and who has no insurance) and thus can’t leave her house, up agaisnt Ann Romney talking about how great horseback riding is for her….and then to hear that insurance doesn’t matter when having a platinum-plated, diamond-encrusted insurance plan obviously *does* matter for Mrs. Mittens….it pisses me off.

I strongly suggest folks wander over to TED . com and look up some of Hans Rosling’s earlier presentations. He’s done great work mining public databases for multiple countries and plotting over time how their commitment to economic expansion or health care played out over the following years. Countries that invested in health care had both larger overall economic growth and more stable economies, where countries with an economy only focus shoot up initially then plateau and straggle for a long time. I’m not doing his “Gapminder” presentations justice, they’re great, please check them out for yourself.

Perhaps one of the problems I see with some of the analysis is the grouping of insured vs. uninsured. Being insured unfortunately isn’t necessarily the same as being able to afford healthcare when you are talking about skyrocketing premiums and deductibles. Just something potentially clouding the waters…

Nonsense, not even close! Infant mortality in the US is 5.98 per 1000 births. There are over 170 countries with higher infant mortality than the US with Afghanistan the worst with 121.63. I’m sure healthcare could be improved in the US but grossly exaggerating matters isn’t helpful.

BTW the main reason for the slightly higher infant mortality rate in the US as compared to other developed countries is the relatively higher rate of premature birth, not poor health care. I could have sworn I have pointed this out to you before. Perhaps it was someone else.

Count me as a Massachusetts resident who was pretty pleased with Governor Romney, but can only view Candidate Romney as completely off his rocker.

I hate having to try and decide between one bunch of clueless morons who think that Medicare’s just fine the way it is vs. another bunch of delusional idiots who think that defaulting on our national debt is a viable political strategy, the Earth is 7000 years old, and AGW is a hoax.

Neither “do nothing” nor “do something, but who knows what it will actually be” is a viable option, but they’re the only two on the table.

BTW the main reason for the slightly higher infant mortality rate in the US as compared to other developed countries is the relatively higher rate of premature birth

Is it just the rate of premature birth, or is it that the US is more proactive in trying to save premature births, and not just filing a 26 wk death as a miscarriage or neonatal death, and not included in infant mortality?

I know there are differences in standards for different countries and I don’t know if that is reflected in your link.

krebiozen, thanks for the link. I don’t mean to derail the topic as Calli pointed out but there must be statistics to compare pre-term and normal birth baby mortality rates (US “last 3 average was even poorer at 7.07). The US has mandated a hep b at birth series which is significantly different from other countries. The WHO states that more than 110 countries have adopted a national policy of immunizing all infants with hep b. There is no straightforward list and I can tell you that in Canada even though this is the formal line recommended by certain medical associations, the only province that immunize infants against hep b are Nunavut and NWT. I looked at the schedules.
I see that MIller, Goldman have looked at the issue (Infant Mortality Rates Regssed Against Number of Vaccine Doses Routinely Given). Even though they say preventing pre-term births is essential to lowering IMR’s, they also note that “nations such as Ireland and Greece, which have very low pre-term births compared to the US, require their infants to receive relatively high number of vaccine doses (23- including hep b at birth in both those countries) and have correspondingly high IMR’s. Therefore reducing pre-term birth rates is only part of the solution to reducing IMR’s.”
The main issue at hand though is universal healthcare which I believe is the right thing.

Is it just the rate of premature birth, or is it that the US is more proactive in trying to save premature births, and not just filing a 26 wk death as a miscarriage or neonatal death, and not included in infant mortality?

Some advocate this but our infant mortality rate is evidence of our failing healthcare system, as when you break it down state-by-state you see how reflective it is of economic disparity. The infant mortality rate in Massachusetts (4.9) for instance, rivals that of any other country in the world, whereas as you spiral down towards the Mississippi (10.9) it is more comparable to Latin American and eastern European post-soviet states. This isn’t due to saving more premies or having a lower age of viability. It’s a failure to invest in prenatal care and screening as well as worsening poverty. Even within states doing well overall there are huge disparities between white infant mortality and that of minorities. Look at the Kaiser data, it’s fascinating.

I don’t recall Mr. Romney saying “it doesn’t matter whether anyone has insurance”. That sounds suspiciously like a strawman. If someone can point out where he said that, or something very much like it, I will, of course, retract and apologize.

Mr. Romney is quite wealthy and may very well underestimate the hardship that paying for routine medical care imposes on those less well off.

O’Donnell called himself a “practical European socialist” in a 2005 interview.[2] Despite regularly expressing support for regulated capitalism and mixed economies, O’Donnell again declared himself a “socialist” on the November 6, 2010 Morning Joe show, stating: “I am not a progressive. I am not a liberal who is so afraid of the word that I had to change my name to ‘progressive’. Liberals amuse me. I am a socialist. I lie to the extreme left, the extreme left of you mere liberals.”[31] On the 1 August 2011 episode of The Last Word, O’Donnell further explained, “I have been calling myself a socialist ever since I first read the definition of socialism in the first economics class I took in college.” O’Donnell went on to state that what he means by calling himself a socialist is.

Not that we choose the socialist option every time but we do consider socialism a reasonable option under certain circumstances; in fact, under many circumstances. As any introductory economics course can tell you, there is no capitalist economy anywhere in the world, and there is no socialist economy anywhere in the world, not even Cuba. We are all mixed economies; that is, mixes of capitalism and socialism, and we all vary that mix in different ways. China has more capitalism, and a lot more capitalism, than has Cuba, but it also has a lot more socialism than we [the United States] do. Our socialist programs include the biggest government spending programs: Social Security, Medicare, Medicaid, as well as welfare, and the socialist program I hate the most, agriculture subsidies. Yes, I’m a socialist, but I hate bad socialism, and there is plenty of bad socialism out there, just like there is plenty of bad capitalism out there, like the capitalism that pollutes our rivers or makes health care too expensive for so many people. I can argue this because every side of this is true: capitalism is good, capitalism is bad; socialism is good, socialism is bad; all of those things are true at the same time. That’s why we have a mixed economy, an economy in which we are trying to use the best, most efficient forms of capitalism, and the best, most efficient forms of socialism, where necessary. So my full truth is I am as much a capitalist as I am a socialist; but since we live in the only mature country in the world where “socialist” is considered such a dirty word that no one would dare admit to being one, I feel more compelled to stand up for the socialist side of me than the capitalist side of me.[32]

Denice- Cameron’s cuts are going fabulously! Things are on the up and up.

Child poverty – up

Fuel poverty – up

Domestic violence – up

Hate crimes* – up

Depression and other MI diagnoses – up

Repossessions – up

Complaints against the NHS – up

I could go on, but frankly, I’m depressed enough. Cameron thinks we should be aiming for US-style welfare and healthcare systems. I think we should be aiming at his head.

*Against people with disabilities. Cameron’s govt has blamed our economic woes on disabled welfare claimants. Violence and harassment against PWD has trebled, suicides have increased, and almost 40 of us die every week after being refused disability benefits. Several are so ill that they die during, or on the way out of their “medical” assessment.

Many have received their “You are fit for work ” notices on the morning of their own funeral, while lazily lounging in a wooden box in an attempt to avoid aforementioned work.

Sure, the previous government started the ball rolling, but as Cameron’s campaign was built around his role as the father of a disabled child (who’d died soon before). As a man who was terribly afraid for the safety of PWD, especially children, under a Labour house.

Camoron and Rmoney are Randroids from the same factory, without a shred of conscience or a molecule of empathy between them.

I formerly worked at one of the UK’s leading cancer hospitals, in part dealing with the deaths in hospital. When reviewing case notes, delays in treatment could be due to relative delays in initial diagnosis, or possibly poor management in their local centre (since some patients had rare cancers which only very specialist centres had real experience with, this was not a huge surprise). However, the largest problem with delayed treatment was usually to do with initial presentation of the patient. Men were historically the worst (and cases of lung cancer would have often only a short period of time from diagnosis anyway), but I do remember the awful case of a former nurse who ignored a lump in her breast, to the point where it was the size of a large coin. It was concluded that she had simply lived in denial.
However, at no time did I ever come across anyone who died because they could not afford to see a doctor, because there is no charge to see a doctor under the NHS. As a father of two young children, one of which has asthma (inherited from me), I am profoundly glad of this, as was the Swiss based British business man who I remember at the hospital who had basically spent all that he and his family had on treatment. He simply changed from a private to an NHS patient – the care was identical, but at least he was not going to be bankrupt or turned away.
The barrier to entry by charging, both for primary and Hospital care makes no sense – it simply delays treatment until it is often too late.

Unfortunately, our current government has decided that the Us system, which delights our right wing politicians and think tanks for its ideological purity, and therefore we might end up with similar horror stories to the one in the article.
If the BBC website allows it, have a look at a two part series called ‘Health Before the NHS’ . It shows how awful the system was before 1948, and how the idea of patient payment ,charities and a patchwork of care simply did not work.
It’s also interesting to see both how private patients were much better treated, and how much many more established doctors fought against the formation of the NHS, using exactly the same arguments that still exist in the US. They were wrong then, and such ideas are still wrong now. They are also expensive, incoherent and inefficient.

It’s a failure to invest in prenatal care and screening as well as worsening poverty. Even within states doing well overall there are huge disparities between white infant mortality and that of minorities. Look at the Kaiser data, it’s fascinating.

While I entirely agree with you about the importance of prenatal care and screening – I’m a Brit and have worked for and supported the NHS for most of my working life – I don’t think the facts support your views in this case. Why do Blacks do so much worse than Whites in Mississippi yet Hispanics do better? Are Blacks and Whites more socially deprived than Hispanics? There is something else going on here, and I don’t think it’s quite as simple as you paint it.

The more I have dug into this issue, the less clear-cut it seems: teenage pregnancy, obesity, prematurity and low birth weight are significant factors which also correlate with social deprivation. There is a good discussion of these issues in this paper which points out that the US actually does better with low birth weight babies than Canada, but has significantly more of them which pushes up the average infant mortality rate.

To clarify my last comment, I don’t think providing good health care for people who are suffering health issues due to social and economic deprivation is enough, any more than providing emergency health care for people with chronic illnesses is enough. I’m somewhere to the left of lilady on this, I suspect.

“Total Births of Hispanic Origin 1,513″, so not huge, as you might expect, but big enough to achieve statistical significance, I would guess, and IIRC the same trend is seen in other states as well. Preterm births in Whites and Hispanics were around 14%, in Blacks 22%. Low birthweight in Hispanics 6.9%, in Whites 9.1% and in Blacks 16.4%. That must surely account for a substantial proportion of the difference in infant mortality. Percentage of mothers beginning prenatal care in the first trimester in Hispanics is 73.1%, in Whites 89.6% and in Blacks 77.3%. So more Black mothers get 1st trimester prenatal care than Hispanics, but infant mortality in Blacks is more than twice that in Hispanics.

So more Black mothers get 1st trimester prenatal care than Hispanics, but infant mortality in Blacks is more than twice that in Hispanics.

Well, there’s certainly something going on. What I was vaguely wondering about was the relative mobility of the populations. One might speculate that the Mexican immigrant population has a return base, which could select for those in comparatively stable situations to remain. This speculation is entirely a product of my own experience with a few folks who work in the neighborhood, though.

“To clarify my last comment, I don’t think providing good health care for people who are suffering health issues due to social and economic deprivation is enough, any more than providing emergency health care for people with chronic illnesses is enough. I’m somewhere to the left of lilady on this, I suspect.”

Wanna bet, Krebiozen?

See my posts on *another blog* …and my dissing of *GOGs* (Greedy Old Geezers) who are on Medicare

Believe it or not, I may be to the left of both of you: I don’t think that we’ll ever really get anywhere unless we go far BEYOND health care… to education.

Notice I can be the blithe socialist and still make money in the market : business should be regulated and citizens’ basic needs should be guaranteed to a certain level in wealthy countries.

There has to be a way we can sell the idea that predominantly middle class societies benefit rich people because there is a large consumer base to buy your products and services and you live in a better place in many ways. It’s like Henry Ford’s idea: pay workers enough so they could purchase the cars they make- on a wider scale.

@ elburto:
It is awful: that’s what happens when children of privilige run social policy mindlessly- not that all wealthy people are like those two. I hope you feel better: his reign as PM can’t last forever. Although a few years can feel like forever.

Definitely not! I just wanted to be clear that my skepticism about the influence of the quality of healthcare on infant mortality is a reflection of my political stance, and you seemed a handy reference point, having just declared your socialist position 😉 I’m not sure how we would objectively measure our respective distances left of center anyway. Feet, meters, Bolshevinches?

Jen: I don’t think you’re very familiar with the US. The “risks” of the Hep B (or any vaccine) do not outweigh the many, many factors that come into play in the first year of life. First of all, there’s pregnancy, which brings someone into the clutches of judgy, judgy ob/gyns, who may or may not be actually invested in the patient, and at the worst, may choose not to save the mother’s life. And that’s if you can *afford* prenatal care.
If one’s lucky enough to have a healthy baby, the parents have to chose between one parent (usually the mother) sacrificing their career, or putting the kid in day care. A lot of parents try to save here, and, in my state, we’ve had a big problem with unlicensed and overcrowded daycares.
Then there’s the premie problem. A lot of premies have respiratory and heart problems. My mom, who works with neo-nates, has had at least two patients who were on the organ transplant list. One girl got her transplant, the other didn’t.
Finally, I agree that Jesus would probably be cool with universal healthcare. However, God isn’t.

Just got in from a drive on highways where there was a lot of reactionary nonsense on billboards, etc. Some major pin-headery – pompous tea party “scientist” gonna *fix* our public schools, prosperity & jobs for everyone, and diet-based cancer treatment, too.
Refreshing to read today’s insolence and the thread. I live in an area with steep political gradients. I live in a good spot, but you don’t have to go far & and it gets ugly quickly.
IWW, eh? soshlists, too. Oh my. It’s good to be home

There has to be a way we can sell the idea that predominantly middle class societies benefit rich people because there is a large consumer base to buy your products and services and you live in a better place in many ways. It’s like Henry Ford’s idea: pay workers enough so they could purchase the cars they make- on a wider scale.

Well, my socialist brothers and sisters, I do suspect that Narad is probably to the left of all of us: more power to him!

On a lighter note:
today’s TMR features a post by Ms Money in which she advises a mother of a newborn ( with GI issues) about a “clean diet and organic food” as well as lecturing her on allergens, toxins, vaccines and immunology. She wants to prevent another case of autism from occuring- she tells her friend what she wishes SHE knew when her own daughter was born.

Fast forward: at 13 months, the boy is diagnosed with PDD. AND the mother questions Ms Money’s ideas about the vaccine-autism hypothesis, calling that idea’s chief promotor “an idiot” and his paper “garbage”. Money is angry that a person could have such strong views without EVER having read AJW’s paper herself or doing “research” on the topic: this new Mom just takes the mass media’s and experts’ word for granted,” falling prey to rampant propaganda”- another viictim of the mis-information campaign.

In addition, she complains that many people who write or comment on blogs ( I wonder who they might be?) are so adamant WITHOUT fact checking or doing their own “research”.
I guess they just dream up their odd theories and data.

PoliticalGuineapig, I totally agree with you that there are many factors that come into play where prenatal and baby wellness are concerned- I have heard horror stories of people in the US who don’t have care or have to pay exhorbitant amounts for that care. I wonder if the hospital portion (fancy, high-grade hospitals with fountains etc.) could cut down health care costs or even doctor’s salaries (though I know the US has a very litigious atmosphere these days). I don’t think the hep b issue is small for many, though. It seems kind of like the straw that broke the camel’s back for many. A lot of people seem to be very worried about bonus-payments for vaccine compliance being tied in with universal health care. As I said in Canada we have universal health care and even if the WHO states that we have a hep b for infants official policy there are only two provinces that have hep b on the schedule for infants.

Jen, where are these fancy hotel-like hospitals? They can’t be very common.

The spousal unit had a knee replacement at one of our two county medical centers recently, and I attend monthly meetings at the other. The lobbys are nice but once you get to the wards and the offices everything’s more like the local Chevy dealership than the Ritz. And we’re in a pretty prosperous area.

Some scientists think that the common differences we do keep seeing — especially the bit about the larger brain volume — might be a clue that what eventually becomes autism actually begins in the womb.

Jen, where are these fancy hotel-like hospitals? They can’t be very common.

That was our experience at the Mayo Clinic. The lobbies were very nice, but the actual working part of St. Marys Hospital was just like the any other hospital. The room was just like the one son was in at our local university hospital. The food spouse and I had at the cafeteria was like any other institutional eatery, with perhaps a few more low fat and gluten free options.

Though one of their brochures did say there are luxery suites at a much higher price. They are not covered by insurance. It looks like one way to get extra funds to help pay for those who cannot pay (like the woman who we help take her stuff from the hospital shuttle to the motel room that she was paying for with vouchers from the Mayo’s social worker), since it is actually a non-profit medical organization.

Narad: Did you ever run into my cousin? I think she was a member of the IWW, and I know she was a card-carrying Communist. Lovely little old lady, who was going to protests on her scooter until she was 90.

THS: Do you come from Wisconsin? I was on a road trip last week and I wore out my middle finger. It’s gotten so bad I’m

Jen: I think vaccines have to be included in universal health care because people won’t get them otherwise. My state had a whooping cough epidemic, and I’m pretty sure there were only two reasons for it: Wakefield, and the fact that the population that wasn’t vaccinating was very, very poor. As for hep B, I do think it’s neccessary. Most people with Hep B won’t even know they have it until they start experiencing renal failure. I don’t know about you, but dialysis is not on my to-do list.
This time around you do seem to be participating in good faith, so I’m trying to be nice. But I’m also going to give you a warning: if you say one word about ADD or autism, the gloves will be coming off.

Shay and Chris, I don’t know the names of the hospitals in Texas but these people described them as being like 5 star hotels – amazing food, beautiful decor, fountains.
I believe specialists make double what our docs do here (ie. orthopedic surgeons) and family physicians make significantly more. All these things are what make up the cost of healthcare- doctors, hospitals and pharmaceuticals.
I saw in one discussion where a man said he paid $9000,00 for a CT scan in the US (15 minutes of imaging) and then paid only 1,200.00 at a private facility in BC. That’s quite a difference and greedy insurance companies can be thanked for that.
Chemmomo and Pgp, I’m not even going to go there about what I think of the necessity of hep b vaccination at birth, I just mentioned it as one of the factors (more mandated vaccines and bonuses for docs who get a certain standard of vaccine compliance) as one of the big issues for quite a few people when it comes to universal healthcare who would welcome it otherwise.

Oooh that last sentence was convoluted. Basically, there seem to be a lot of people who are nervous about universal healthcare for reasons to do with vaccination compliance, whereas they don’t seem to be as concerned if they have private insurance companies.

The lobbies were very nice, but the actual working part of St. Marys Hospital was just like the any other hospital.

That’s interesting. A few years ago in the UK, I worked for a hospital that was part of a large private medical organization, i.e. non-NHS, for a couple of months. I had a good nose around while I was there. The private rooms (no wards) were lovely, the hospital set in beautiful leafy woodland and the food, at least the food the staff ate, was excellent. We even got free tea and coffee.

However, the laboratory I worked in was using a computer system that appeared to have traveled through a time warp from the 1980s, in fact it was far more primitive than the system I was using in an NHS lab in 1986. It had a text interface, for goodness sake. Unbelievable. I also discovered the analyzer I was assigned to hadn’t been serviced in years and was giving the wrong results.

My impression was that appearance was everything, but under the surface and behind the scenes things were not as good as the NHS, and to my surprise the pay the lab staff got was lower than the equivalent NHS pay (I was working as a locum through an agency, so was thankfully being paid considerably more).

Of course if anything went badly wrong the patient was sent to the nearest NHS hospital, where often the same consultant would use NHS resources to clean up the mess.

Basically, there seem to be a lot of people who are nervous about universal healthcare for reasons to do with vaccination compliance, whereas they don’t seem to be as concerned if they have private insurance companies.

Living in the UK I don’t remember ever meeting anyone who was at all concerned about vaccines, or anyone who wanted to see an end to universal healthcare. My GP was running low on flu vaccine last week when I went for my shot, and I had to use all my persuasive powers to convince the nurse I needed it (I have been having episodes of coughing, wheezing and turning blue lately, so I think the vaccine is wise), so I don’t think uptake is low in my area. Just saying.

Wouldn’t private health insurers be more likely to refuse you coverage, or quibble about reimbursement, if you were not up to date with your recommended vaccinations? The thing about universal healthcare is that it’s universal, in theory at least.

Krebiozen, the Mayo Clinic is private, but it is still a non-profit. Due to its reputation it attracts lots of wealthy patients, whose names adorn plaques in the lobbies that they help fund. It also includes a health clinic system and medical school.

Krebiozen, I am not sure about the private insurers, I just know that many people seem to equate universal healthcare with a lot of negative things- forced procedures etc. Here in Canada I just don’t see that happening. My family can opt for the kind of treatments that we want, in consulting with our doctor. We aren’t “forced” to do anything. Most people are happy with our system, albeit some wait times are too high (for example for colonoscopies).

Narad: Did you ever run into my cousin? I think she was a member of the IWW, and I know she was a card-carrying Communist. Lovely little old lady, who was going to protests on her scooter until she was 90.

My “new” downstairs neighbor (scare quotes because she’s been in the building for ages but only just moved close to me), an octogenarian, was a long-time organizer, so there might be but a handful of degrees of separation. She’s very much cut from the Faith Petric cloth. John Prine had to use her piano when he hadn’t one of his own.

Basically, there seem to be a lot of people who are nervous about universal healthcare for reasons to do with vaccination compliance

Have you ever considered the possibility that this perception on your part is merely part and parcel of the atavistic delusional power complex that the antivaccine movement uses to convince itself that that it’s not actually a socially marginal freak show?

Narad: No. Forced medical interventions in general are mentioned. My parents-in-law have a place in Florida and she says the Republicans there really like their level of care and are very afraid to take the chance on universal healthcare.

Okay, Jen. That makes sense. One reason that some hospitals have them is that they are for profit organizations. If they are not, it is often to bring in more money to take care of those without insurance.

Like the woman we met after she was discharged from the Mayo hospital on the patient shuttle. She had been airlifted from Wisconsin with a septic infection, and went surgery to remove the damaged area including part of her collar bone. She was taken care of, and give a voucher for a motel (the one next door to our hotel) to stay in for her follow up care.

I am sure that the Texas Medical Center, Baylor School of Medicine and their associated hospitals (which includes both Methodist and St. Luke’s) all have similar programs.

So, yes, the USA needs universal healthcare. Then you would see fewer luxury suites that help pay for those who do not have insurance (and the hospitals are obligated to treat).

Narad: No. Forced medical interventions in general are mentioned. My parents-in-law have a place in Florida and she says the Republicans there really like their level of care and are very afraid to take the chance on universal healthcare.

Because of forced vaccination? And, by any chance, are these in-laws already on Medicare? Because this is what “have a place in Florida” generally suggests.

Not just forced vaccination but other interventions as well. I can’t really relate to that, though, since in Canada we have universal health care and yet as I said, we can decide on what interventions we want to have (vaccination,circumcision or no etc.).

Not just forced vaccination but other interventions as well. I can’t really relate to that, though, since in Canada we have universal health care and yet as I said, we can decide on what interventions we want to have (vaccination,circumcision or no etc.).

Can you identify a single “forced intervention” that would be apropos of your story of Canadians with a second house in Florida who you seem to believe have taken the pulse of the population, which, as things stand, is apparently opposed to socialized medicine by virtue of having it?

I think I have to clarify. I am aware of many Americans being nervous of “Obamacare” in that if they don’t accept certain interventions- prescriptions, vaccines etc. then services will be denied them. My in-laws have known many Republicans who do not want to lose the level of care they have had through their health plans.
In any case, doctors, hospitals seem to cost the US system a lot of money relative to other countries. Health insurance profits are high. There are probably in many cases gross overcharges – like the guy whose CT scan cost 9,000.00 compared to 1,200.00 in B.C. Maybe insurance has to get out of primary care.

No Jen, the only hospital that I am aware that ever had a fountain out front is a teaching hospital providing specialized child care. It is part of a large not-for-profit hospital located in Queens, New York.

The fountain was turned off years ago, because the Canadian geese which had taken up year-round residence on the hospital grounds were polluting the water with their goose poop.

The biggest mistake America made was not selecting Howard Dean as their 2008 choice for democratic representative for President. He would have pushed through nationalized healthcare and removed all the third-party leeches.

I think I have to clarify. I am aware of many Americans being nervous of “Obamacare” in that if they don’t accept certain interventions- prescriptions, vaccines etc. then services will be denied them. My in-laws have known many Republicans who do not want to lose the level of care they have had through their health plans.

Perhaps you could get to the part where this is supposed to make sense.

Politicalguineapig: I know what you mean about Wisconsin. I lived in Wisconsin for many years. Now I live in Western Oregon. My previous comment about political gradients, etc. is reasonably applicable to both states. WI had the LaFolette senate seat taken by McCarthy. But then there was Gaylord Nelson. There was a good liberal run (60’s/70’s) but the evil underbelly now has the upper hand, I fear. Wisconsin was the center of American timber industry. They logged the Great North Woods & moved west.
Relevant to this thread: Our current governor, John Kitzhaber, is good on health care access.

Stanford Hospital provides concierge-type services to wealthy private-pay consumers from the local upper class as well as medical tourists. They also accept a wide variety of middle-class types of insurance as well as various forms of socialized medicine (Medi-Cal aka Medicaid, and Medicare) because they’re a teaching hospital.

I’ve only been in the clinics and outpatient services, which seem fairly nice but not opulent. The primary care divisions moved out of a 1920s-era building with nice Art Deco flourishes outside but its systems upgrades were kludges that needed to be redone without tenants in place. So the family practice and internal medicine clinics relocated to a new medical building nearer the hospital (and further from the train/bus station). The new building is decorated tastefully, but I wouldn’t call it extravagant.

The main thing I noticed was that the new carpet gave off such fumes I couldn’t breathe. And I wasn’t the only one; some employees had to get transfers because they got sick, and the waiting rooms soon had industrial-size air cleaners.

Completely OT: In the hospital building behind the fountains in the photo, there are research labs as well as the patient services. One of those labs belongs to Andrew Fire and Craig Mello, two Nobel laureates for their study of apoptosis.

In Chicago, there has been a lot of rebuilding as hospitals buy each other, combine networks, and so forth. The private rooms and all the fancy stuff is a competitive thing. It’s not really necessary, just Advocate keeping up with Loyola keeping up with Cadence keeping up with Rush, et al. There are all the gritty hospitals in the poorer areas which don’t have all of the amenities, but there are hospitals.

Some hospitals will do their best to stabilize and divert uninsured patients to public facilities (usually Stroger aka Cook County Hospital). Illinois is way behind in paying the bills, and nobody wants to get stuck with IOUs.

Taking the insurance companies out of the mix could help a lot in terms of lowering health care costs for all. The biggest problem I see is the potential for fraud, as exists in Medicare.

Romney’s flip flopping on this issue is a joke, which I find morally repugnant. The Republican party has wiped out those who used to be able to buy all the mass produced items made by people that used to make them here. Romney outsourced their jobs overseas, many of us are unemployed or underemployed, and can no longer afford to buy that stuff. We’re more interested in eating, paying the rent, and trying to stay well.

Doubtful that there can be any meaningful health care reform in this country until the trail lawyers are forced to make a few concessions … It would be illuminating to see some figures on how much of our high healthcare costs actually are “lawsuit insurance” vs. “health insurance”, for example.

Jen: Of course Republicans would be nervous. God forbid other people (especially people with brown or black skin) could actually get coverage! Or that parents couldn’t get a doctor to help straighten out their gay children. Or young women have other choices then a ‘name and shame’ Christian birth center.
Seriously, you know how bad it is here? I turned down a ride to the emergency room because I was worried my insurance would drop me. (It was a very minor accident, and my poor little bike took most of the damage.)

Narad: your neighbor sounds like the type of person my cousin would know. I don’t know her last name, but ask if she knew a woman named Helen from Marin who traveled a lot.

Pgp, that is terrible and consistent (unfortunately) with stories I have seen or heard about even professionals (teachers, geologists) going to great lengths to deal with health crises -a teacher having a lemonaide fundraiser to help pay for their cancer treatment.Someone jut told me about a geologist who changed companies to get new,more? inurance because his wife had cancer. It’s all just so wrong. The third party leeches need to go.

Things you never see in the UK: people dying because they couldn’t afford to see a doctor, people committing serious crime to pay for their sick relative’s medical bills, people in debt for life/stripped of their estate because they became ill.

Normal private/public rules of efficiency are reversed for healthcare because, except for the local hypochondriac or two, people only take what they need. Nobody breaks their own leg to gain a free crutch.

Our NHS also has huge independent buying power, which it wields to great effect with the drug companies. It’s the UK’s most cherished institution – hence the Olympics display.

@Mark McAndrew:
In Australia, we have a similar pharmaceutical scheme – the PBS. It means I get many of the meds I need to keep functioning at a rate I can afford, and people with less income than me get their meds even cheaper.

The US drug companies HATE it, and always put it on the agenda in the US-Australia free trade agreement talks. And I think even our current rabid loony opposition knows it would be political suicide to try and dismantle the PBS, even though they want to cut so much more health care.

Jen:Okay, so why are you against universal health care? Because of vaccines? Because of the constant “threat” of autism, ADD and ADHD? You seem to be an intelligent person, except for these strange fixed ideas.
As I pointed out earlier, opposition to universal health care among the senior set basically boils down to the idea that other people don’t matter. They might care (maybe) if their children (or grandchildren) had a sudden medical crisis and were facing bankruptcy. But when it comes to other people’s children, other people’s grandchildren, especially those of the wrong color, they just cannot be persuaded to give a rip.

Mark: I wish I could thumb up that comment. I loved the opening celebrations, but it made me sad that the US would never celebrate doctors, nurses and writers.

In any case, doctors, hospitals seem to cost the US system a lot of money relative to other countries. Health insurance profits are high. There are probably in many cases gross overcharges – like the guy whose CT scan cost 9,000.00 compared to 1,200.00 in B.C. Maybe insurance has to get out of primary care.</blockquote

While I'm certainly not the world's biggest fan of insurance providers, I don't think their profit margin is really the main cause of high prices in the US.

It is absolutely true that the US overpays for health care. And not by a little bit, either — we lead the other nations of the world by a staggering margin in how much we pay, per capita, for our health care. Yet our outcomes are among the bottom of industrialized nations. (Sure, we're ahead of places like Afghanistan, but that's hardly something to be proud of when you're the richest nation on earth.) This is counterintuitive, but there are reasons for it.

Part of it is a huge skew in the numbers. Some people do get health care for a reasonable price, and get good outcomes as well. They are not the majority. They are the wealthy, and they are insured. The majority have inadequate insurance or no insurance. If they are poor enough, they may qualify to get substandard free care. If they are less poor, they will not qualify and will have to decide between bankruptcy and getting that suspicious lump checked out.

The majority of Americans too young for Medicare are unable to qualify for assistance, but do not have adequate health insurance. They will skip preventative checkups, which are especially critical in pregnant women and very young children. They will skip vaccinations. They will skip recommended screening. After all, none of these things will kill you if you skip them. They just improve your odds, so if it's that or this month's rent, you're going to pick the rent. They're probably also not getting their eyes examined regularly (even if they do need glasses) and they are probably not getting their teeth cleaned every six months — and it's amazing how seriously that can impact your health. In fact, you're more likely to have serious health problems from skipping your dental checkups than from skipping your physicals, because dental infections have a nasty habit of becoming systemic in short order.

I once processed a credit application from a guy who had lost everything because of his bad teeth. He never saw the dentist. Refused to. He finally wound up in the ER with an infection in his heart that originated from his rotten teeth. All his teeth were pulled, and replaced with dentures. He was in the ICU for a while, until the infection cleared up. It ate up everything he had and he still had to declare bankrupcty; by the time I got the credit app, he was struggling to put his life back together. People don't realize how bad it can get, neglecting your teeth. But then, if you're one of the millions of Americans who can't afford groceries, rent, and the utility payments, you don't have much choice, especially if you make too much to get charitable dental care.

I've rambled a bit. Anyway, people like that are why health care ends up being so expensive in the US. Not because it is intrinsically more expensive, but because far too often, things are being treated much later. Magnifying that is the problem that those who can't afford a $150 checkup certainly can't afford a hospital stay — so if they're getting treated hospital style, the hospital is not going to be able to collect on their bill. And so, the fee gets passed along to others.

Another complication is they can't pass the bill along to everyone. Insurers don't like paying for other people's care (obviously), so they negotiate rates that they feel are appropriate. I had an MRI with contrast last summer. The hospital's bill was over $3,000, but the negotiated rate was about half that. I think what's going on is that the hospital is trying to cover the cost of those who can't pay by passing the fee along, but since they can't pass it to the insured, they have to pass it to the small subset of uninsured who can pay, and so they have to really ramp up the billed rate. That's my hunch, anyway; I'd love to see somebody dig into the billing practices and figure it out.

Part of me would like nationalized health care simply so we'd have a mechanism for auditing these things in a consistent manner.

I did read about Thompson’s kid’s crapola. There is something about that sick but somehow slick crowd – I must choose my words carefully…maybe it’s the dress code & hairstyle. Smug “preppie” goons with overweening sense of entitlement.

The other countries reviewed have systems ranging from actually socialist, such as the UK’s NHS, to regulated but privately-run, such as the Netherlands’, which if memory serves most closely resembles what PPACA could lead to.

Except that the UK’s NHS isn’t socialist. While the cost of health care is covered by public funds accued through taxes and other revenue streams, the physicians, nurses, etc. providing health care are independent contractors.

If that’s socialized medicine, any state or federal highway project is socialized construction, McDonnel Douglas is socialized aeronautics, etc.

That’s news to me, having spent 23 years working for the Department of Health via the NHS as an employee, paid by the NHS. The only time I have been an independent contractor is when I have worked through an agency as a locum. It may be headed that way, already some doctors are essentially independent contractors, and I notice that many of my GPs are now contractors, but the vast majority of people working for the NHS are employees. Perhaps I miss your point.

My allergist told me years ago that asthmatics who are hospitalized are twice as likely to die of asthma as those not hospitalized.

It served to keep me on my preventative meds.

I am a healthcare socialist because I know this is true, as ORAC has outlined, for so many other conditions.

Plus, as a lifelong asthmatic, I know that the ER is not a place for ongoing treatment. They do a great job of getting me back to a working level, but not necessarily of getting me well. I need follow-up and ongoing specialty care for that.

Being a serf to my employer so I can obtain that care is, well, feudal.

People who can’t access needed speciality care dying earlier than those who can, is criminal.

My understanding is that in the UK almost all general practioners, specialists, etc. are self-employed practicioners who’ve contracted with the NHS to provide health care services, rather than being public service employees. Has that changed in recent years?

My understanding is that in the UK almost all general practioners, specialists, etc. are self-employed practicioners who’ve contracted with the NHS to provide health care services, rather than being public service employees.

That’s just doctors, don’t forget the army of hospital staff: nurses, physiotherapists, radiologists, laboratory staff, pharmacy staff, receptionists, clerical staff etc. etc. who still make up the bulk of NHS staff and are mostly employees of the local hospital trust which is funded by the Department of Health. However I don’t want to frighten people away from a sensible system of healthcare just because it has socialist connotations, or to put anyone off driving on socialized roads so I should probably shut up. 😉

The US is the only “first world” country that doesn’t have universal health care. Much poorer countries have it, such as Mexico, and even poorer countries in places like Peru and Guatemala. That, to me, is shameful. Obviously, Jen will disagree. Why spend money on making lives better when you can spend it on, say, something stupid, like bombing the heck out of a country like Iraq?

WOW, Pgp and Bad poet, where on earth did you get that I am against universal health care?? I totally support it. I’ll say it again. I am totally in support of universal healthcare. No hesitation. In Canada we have it and I think it is the only humane option. I am aware, though, of many Americans being nervous about forced vaccinations/medications (statins for one ex) as being a possible consequence of universal healthcare but we do not find that to be the case in Canada at all. Nowhere did I say that I am against it and I am actually offended that bad poet would characterize me the way he did. I am Canadian but I think the US spends/wastes way too much money on wars – another reason I would vote for Obama- if I were American. I also appreciated what Calli had to say- I still wonder about insurance company kickbacks and think insurers should be out of primary care.
Jen (who believes in universal healthcare)

Yes, my Canadian in-laws hear that their Republicans buds in Florida are nervous about our (Canadians’) wait times for certain procedures and the possibility of insurance co’s insisting on certain medications, like statins.

Narad do you believe in universal healthcare? Straight answer would be appreciated. You may not like what I have heard -( long wait times and forced medical interventions like vaccines and medications as being concerns in terms of universal healthcare) but I assure you I am not making them up. Why would I?

I was poking around the CDC’s Vital Statistics site, and I discovered something downright bizarre.

Black women are three times as likely to deliver prematurely. We’ve known this for quite a while. At first, folks assumed it was socioeconomic, but the pattern seems to hold even among middle-class Black families with access to health care. Then they checked genetics. Nope, African immigrant women don’t have too many preemies.

It’s an important question, all these extra preemies means a lot of sick or lost babies, and it’s fascinating. Researchers are tossing around explanations like epigenetics and psychosocial stress, but no one really knows.

Jen: Schools and certain jobs require certain vaccinations. Why would it be a catastrophe if vaccines were required to participate in government programs? And I don’t think ‘forced medications’ is going to happen, because in almost all cases, the patient gets the final say. (The only exception that I know of is in the case of medications for schizophrenia.) I’ve been on and off meds, I’ve currently been off for *years* and if universal health care were implemented tomorrow.. I’d still be off them and no one would notice or comment on it.

JaneW: My guess would be stress. A lot of African-Americans carry around a huge load of stress- either socioeconomic, worrying about finances, or just having to navigate society’s casual racism.

I personally don’t believe that enough real safety studies have been done on vaccines. Never mind what I think- it’s quite obvious a lot of parents have concerns about them. They seem to include more on the US schedule than anywhere else. For ex in the Britain they don’t vacc for chicken pox and certainly not hep b at birth. Anyhow, it doesn’t matter what I think, it’s what American voters think. I tend to agree with you that universal healthcare doesn’t need to mean controlling people with medical interventions-it certainly isn’t that way in Canada. But- in Canada insurers are out of primary care. I wonder if Narad is in insurance?

Narad, you supposedly believe in universal healthcare but don’t seem to really seek understanding as to why so many of your countrymen would oppose it. What is your theory as to why they would oppose it? Do you think it is only the wealthy who oppose universal healthcare? What are your theories?

At the risk of putting words in Jen’s mouth, I think her point wasn’t that universal healthcare is bad, but that her relatives who have homes in Florida are concerned that it will be, probably unreasonably so. And this is actually a pretty fair reflection of much of America. There is a bizarrely strong sentiment against universal health care in this country, or even single-payer (which is actually somewhat less than universal health care, as it doesn’t establish anything like Britain’s NHS but allows hospitals to go on competing and running themselves much as they have). And recipients of Medicare do present a fairly significant block within this, counterintuitively.

I think a lot of the problem is that many people can’t get past the word “socialized” in “socialized medicine”. They think it’s those damn commies. Communists were so effectively othered during the Cold War that anything that even uses the same words is hard to pass. There is also a strong sentiment against public welfare in this country, probably inherited from the Puritan philosophy that you reap as you sow — if you are wealthy, you must deserve it, and if you are poor, you must deserve that too. There are many people would deny welfare to a thousand deserving families on the basis of one anecdote of an iPhone-wielding Cadillac-driving welfare mom on crack.

So there is a philosophical objection to universal healthcare in this country, simply because it’s a sort of welfare and there is a strong objection to welfare as well. Hang out in the comments on Yahoo! News and you are sure to meet these people eventually. It can be quite depressing to come face-to-face with such willful ignorance.

And then there is another unreasonable reason to fear universal health care — the conspiracy theories. And these got a major shot in the arm from the Tea Party recently, who pushed them into the mainstream. When the Affordable Care Act was being debated, there was discussion about allowing Medicare recipients to be reimbursed for discussions with their doctors about living wills. In the hands of the Tea Party, particularly folks like Sarah Palin and (ah, woe betide my home state) Michelle Bachmann, this became death panels. To sway voters, they started claiming that the government would be decided who would live and who would die. Pundits went so far as to talk about Uncle Sam killing Granny to save a few bucks. So of course the elderly were especially frightened. Who wouldn’t be? (Well, anyone who fact checked it, for instance, but besides them.)

Those are some of the main objections I’ve heard to socialized healthcare in America. The folks who say its unAmerican to be in favor of any kind of handout, and the folks who go wacko conspiracy theory about it (yet, amazingly, manage to get airtime).

Oh, and it isn’t just the wealthy who oppose universal healthcare, But they are a strong contingent against it. The wealthy tend not to be against it on the conspiracy theory grounds, but they are more likely to support the philosophical grounds (after all, the Puritan model is far more appealing if you happen to be rich, since that means you must be righteous).

Calli, my parents-in-law do support universal health care but they do happen to have a really good insurance pkg through his retirement plan- one that allows them to travel to the US and not be too worried if anything happens to them. Admittedly health care is only one issue in terms of the election- it may be that increased taxation ties into the issue in a big way (although the cost of health insurance seems very high! And surely people must realize that illness can strike anyone at some point).
I guess Canadians and Brits just don’t have that Puritan objection to making sure everyone is taken care of. I haven’t heard of ‘death panels’ but euthanasia seems to be topical lately and it does concern me. It makes me sick to think of that idiot that made sure his wife (TerrySchiavo) would be starved to death- her mother not even allowed to wet her mouth for comfort.

Ah. I missed this attempted shill gambit. As I’m not in the mood for the composition of a lengthy insult in return, the answer is “no, but if you can open a sinus in an epidermoid cyst, I would appreciate your assistance after checking your gums.”

Jen: I can think of two reasons for the difference. First of all, I suspect that Britain has less of a hep b problem than the US. Secondly, parents might skip the chicken pox vaccine in Britain because..gee.. they actually can take sick leave there and know that the job will still be there when they come back. In the US, that doesn’t happen; most low wage jobs don’t even have sick days.
And again, we already require vaccines in school and health care settings- why would that be a bad thing? Do you really want a nurse spreading flu around a hospital ward? Do you want quarantines every winter?

I think a lot of the problem is that many people can’t get past the word “socialized” in “socialized medicine”. They think it’s those damn commies. Communists were so effectively othered during the Cold War that anything that even uses the same words is hard to pass. </blockquote.

Nothing destroys the "evil communist" mind-set more than being told you are living in a communist community in the 1970s. When I lived in what was then the Panama Canal Zone a high school English teacher told us that we were living in a communist community (not just an imperial colony with enforced racism).

In the Canal Zone everything was owned and operated by the US Dept. of Defense. First there was the Panama Canal Company that essentially owned all of the "civilian" operations and facilities (including homes), and the governor was an officer in the Army Corps of Engineers. If a light bulb was burnt out, you could call the Pan Can Facilities and someone would come out and change the bulb. The commissary, cafeteria, sports facilities, schools, theaters, etc. were all run by the Pan Can Company.

Then there were the military bases, that were only different in that there was a gate you needed to pass through and the Post Exchanges required military identification. Which I had since I was an Army brat.

Military brats had a bit of posh because they could shop on base, but often we only lived there in three year stretches, While the Zonians did not have to move away. Though they could be exiled. There were over twenty bomb scares in my high school in one year. When the culprit was discovered they were escorted to the airport and sent stateside (at least that was the rumor).

And, of course, we all enjoyed the socialized medicine through the military clinics and at Gorgas Hospital.

By the way, something I know because I married an ex-Canadian whose relatives live just north of us… When Canadians travel to the USA they have to pay money to make sure they have health insurance here. I think it may be from Health Canada.

Also… while I was living in the Canal Zone many of my friends were Canadians living in the Republic of Panama (some of the parents were contractors working on a large construction project for the republic). They made sure to fly back to Canada for medical treatment.

Narad, you haven’t contributed to the discussion of universal healthcare except to respond to IMR’s and question me as to why my in-laws Reuplican friends in Florida are against universal healthcare. I have suggested they don’t want ‘forced’ meds (like statins), long wait times, and yes the vaccine issue may be shared as much by young people- parents. If you are passionate about UHC and think it’s important, I would think you would be intereseted in looking at why. Maybe you don’t care so much, I don’t know. You are presumably in the medical field. What area?

Pgp, I’m really going to sidestep particulars on vaccines except to note that the US has a few more than some other countries. Again, it doesn’t really matter what I think but what Americans think and how much of a bearing it has on the issue of universal healthcare- obviously the objectors point to several concerns-some Callie mentioned, not the least of which is the welfare stigma. I certainly believe in universal healthcare but the insurance companies seem to be soaking up too much of the costs there.

Jen: Oh, no, you don’t get to do that. You ceaselessly troll threads on vaccines (at least you’re brighter then some of our usuals) and you don’t get to sidestep that history. You also don’t get to do a ‘well, yes that’s good, but’ routine. And you certainly don’t get to dance your way around the questions you raised in the first place.
Either you’re for health care or against it. And you might have missed it, but statins have fallen out of favor these days.

As for Terry Schiavo- that was an extremely rare case. She was brain-dead, in case you skipped over that bit. Once the brain is gone, what’s the point of maintaining an empty shell?
Honestly, during that case, I considered writing up a last will so any loved one of mine would have no ambiguity over what *I* wanted. (I haven’t yet, but I don’t want to leave a paper or digital copy around the place. My family might think I’m suicidal.)
Also, please drop the passive-aggressive bull-sh*t. I just watched the debates, so I can’t be having with any more nonsense today.

When I was flying gliders, another pilot in the club told me about a friend of his who had a an air charter business. During the winter a significant portion of his friend’s business was flying Snowbirds* back to Canada for medical treatment. I always think of this when I hear know-nothing Americans talking about bad socialized medicine is and how long our waiting lists are.

*Retired Canadians who spend the winter in the southern US, usually Florida and Arizona.

Thank you, Militant Agnostic. I usually hear my hubby’s aunts complaining about the cost or mentioning they almost forgot to buy the insurance. I never hear the details, plus how great Health Canada is even with its problems.

Pgp, I brought it up (vaccinations) as a concern of some who oppose UHC and as a point to do with IMR’s but as Liz Ditz pointed out it had been covered on another post. Righly or wrongly, forced interventions in the way of medicines, vaccines, long wait times for procedures, “death panels” etc. etc. may be reasons for some to be concerned about universal health care. As I have said, in Canada we find no such concerns. Insurers need to get out of primary care.
Narad, why post if you have nothing to say?

ASDmama, I can’t really speak fbuttery one here but it is really infuriating when you see people who claim to be on the spectrum (people like Alain- autistic lurker) actually actively dismiss the severity of what autism is for many and denigrate the parents who feel their child’s autism was caused environmentally (vaccines). Maybe this won’t be posted because I know it’s a touchy subject but as an Ed assistant who does front line work, I feel really upset when someone like autistic lurker (who speaks, writes, toilets himself etc etc.) think they speak for all children/adults with autism.

Posted by: Jen | October 23, 2012 at 11:11 AM

“Claims” to be autistic jen? Who in the hell do you think you are? The purveyor of who gets to be an autist or not? And nice strawman to boot; Alain never said s/he spoke for all autists but given what detritus you mire in over at that scum pit and what you do think of autists, I’d take Alain’s representation of autists over your’s any day.

The implications to me (and I don’t want to be accused of setting up straw men, which is why I asked) is that if anyone does not get any treatment that might be of benefit to them in time for it to be of benefit, that is a complete failure of the system. Thus if, say, someone can’t get a heart transplant for whatever reason, that’s criminal. Reasons could include:
– ability to pay
– availability of appropriate medical professionals, facilities, or supplies within a suitable distance
– transportation to/from such medical professionals, facilities, or supplies

These could all be resolved by:
– provide all health care at no cost (or means tested)
– ensure that all people are close enough to a medical facility equipped for all possible issues to be worthwhile
– provide transportation to such facilities gratis (or means tested)

Because of the words “criminal” and “barbaric”, which in my view you use to demonize those who do not agree with you, you are perfectly content to substantially increase the cost of medicine in order to be sure that every person has easy access to any possible procedure.

Nice group you’re aligned there with jen. Maligning an autism fundraiser just because they didn’t give lip service to your vaccine crap and had higher functioning autists performing. You people are pathetic.

To add on, what other things might be considered criminal? If someone lives in a place with a higher risk of death (for whatever reason), is that criminal? If one drives a vehicle with a low crash survival rate? If one over or under eats?

I’m not talking about personal choices here – should government be in the business of ensuring that every person has all of the safety and health advantages of every other person? It sounds nice – is it practical? If you think that not doing it is criminal, I suppose you’d have to do it regardless of the cost.

I feel Orac made a good and important post on the issue of universal healthcare. I don’t think there is anything wrong with speculating on possible reasons that some (not me- as I said, I’m strongly for universal healthcare) are against it. It’s too bad people like Science. Mom and Narad have wasted time tracking what I’ve said on other (unrelated) posts. Some of us were trying to actually discuss this. I will take myself out of the discussion and maybe you can address some of Oleander Tea’s more substantive queries. I at least enjoyed and appreciated what some of you had to say on the issue.

It’s too bad people like Science. Mom and Narad have wasted time tracking what I’ve said on other (unrelated) posts.

You brought the matter to the table right here, Jen. I assure you that I have precisely zero interest in “tracking” your remarks far and wide.

I don’t think the hep b issue is small for many, though. It seems kind of like the straw that broke the camel’s back for many. A lot of people seem to be very worried about bonus-payments for vaccine compliance being tied in with universal health care.

I am aware, though, of many Americans being nervous about forced vaccinations/medications (statins for one ex) as being a possible consequence of universal healthcare but we do not find that to be the case in Canada at all.

“Interesting parallel between studying insured/non-insured and vacc non-vaccinated. I think in light of your country having one of the highest infant mortality rates and the most aggressive infant vaccine schedule at least more animal model studies need to be done to compare safety (or tease out the variables in studies of the many who have already opted to not vaccinate).”

Will you excuse yourself from posting that comment or else, do you need my lawyer to call you to confirm that I’m really autistic, that I never dismissed the severity of the symptoms and while I disagree with your conclusion that it’s the vaccine, I never denigrated anyone and finally, do you need my lawyers to tell you that I speak for myself?

Oleander Tea and Mephistopheles O’Brien,
Universal healthcare is no panacea. Resources are always going to be finite, which means that lines have to be drawn somewhere and difficult decisions made. Personally I find attempts to make objective decisions about this using various measures like QUALYs a bit distasteful, but like disposing of sewage, I suppose someone has to do it.

It’s too bad people like Science. Mom and Narad have wasted time tracking what I’ve said on other (unrelated) posts.

Narad did no such thing; your lousy reputation simply precedes you. As for me, if you are embarrassed by your slimy malignments of others, then maybe you should say, not conduct your “business” in public?

Alain, I didn’t mean to upset you and I’m sorry for that. Lilady is right, they are vile, despicable creatures who try to elevate their status by knocking others down. There is a lot of loathing over there for autists they don’t think “suffer enough” or “don’t have it as bad as their children”.

Jen: The infant mortality rate proves nothing. It counts children from neo-nates to two and includes *every* death- SIDS, drowning, shaking, heart arrythmia, pertussis, car accidents.. There’s nothing there to prove that vaccines are dangerous. Or at least, not anymore dangerous then the average toddler is to themselves. I know a mother whose son pulled an end table down on himself, and my sis fell out of a tree at that age. (Sis was fine, the boy had to have surgery on his thumb.)
Question to all: Let’s say J.D. from Podunk just got his toddler, D.D. vaccinated. Two weeks later, they’re out on the highway, get into an accident. D.D. is pronounced dead at the scene. Would the cause of death be vaccinations? I know Jen’s answer, but let’s hear from the rest.

Krebozien: I don’t think anyone expects universal health care to be a panacea. I just don’t think people should go bankrupt because of illness or injury.As I said, I don’t want- or expect- extraordinary measures. But y’know, I’m never going to get any job that isn’t minimum wage, even with a BA, and it would be nice to know that I could go to a doctor without (once I’m on my own) forfeiting grocery or rent money.

Don’t sell yourself short. I don’t know about your education and background but you’re certainly literate and probably have other skills that would be attractive to potential employers. Sometimes getting getting more computer/ office skills makes a great difference quickly.

I just don’t think people should go bankrupt because of illness or injury.

Of course not. The fact that anyone, especially in the developed world, should go through such an ordeal seems utterly grotesque to me. I was just pointing out that even when you have universal healthcare there are still difficult decisions to make. Here in the UK from time to time we hear of someone being refused a potentially life-saving treatment because it’s too expensive, for example.

If you have limited resources, do you do one heart transplant on a younger person or a dozen hip replacements on elderly people? These kinds of decision are going to become more frequent as the population ages.

it would be nice to know that I could go to a doctor without (once I’m on my own) forfeiting grocery or rent money.

That is just so wrong. My American wife had surgery for carpal tunnel a couple of years ago. It didn’t cost us a penny, thanks to the NHS. Even the post-op painkillers were free. You can imagine how astonished she was.

@ Alain, I notice on some posts you made Oct. 5th and 6th that you and Lilady both thought it was o.k. to question Jake Crosby’s diagnosis and you even made a comment to the effect that he had a mental illness. This was besides commenting on his course work and specifics on that. So it’s o.k. for you to do this, eh? Some of the company you keep are quite vile (Lilady has speculated on other childrens’ diagnosis- does she have access to their files, or what?) and maybe they’re not a good influence on you?

Jen, is it necessary to remind you that one AoA commenter on Olmsted’s recent regurgitation from Tony “I have looked high and low” Bateson who had the temerity to state that she had unvaccinated autistic children promptly had her veracity questioned?

Jen…I’m back now. I don’t recall the specific comments I made about Jake. I have questioned his diagnosis, his stalking behaviors on the internet and in person and his deplorable lack of decency and civil behavior. I periodically mention Jake’s “Six-Sixty-Six Hundred Degree of Separation” blogs and his libelous posts directed toward doctors, scientists, researchers, and journalists.

There’s two sides to Jake stalking story; Jake’s side which you believe and the other people side which I weight in along with ADI-R and ADOS diagnostic requirement of restricted interest which I also weight in and finally, I also weight in the social disability common to people with a diagnostic of asperger syndrome (and autism for that matter).

Given what I use in the previous paragraph, you can’t say that I question his diagnosis; he does a very fine job of displaying it himself in his few videos on youtube.

Now regarding the speculation about his mental health, I stand by it because stalking in itself isn’t a diagnostic criteria for autism or asperger syndrome and has been linked with mental health problems and I also disclosed many studies and case report of stalking behaviors associated with mental health problem in my original posts on ScienceBlogs (which I can dig up and post here if needed).

From now, I can refrain from speculating about Jake Crosby but I’ll ask you to refrain from speculating about me:

First, I am indeed autistic; I have not been associated with the neurodiversity movement for a long time and I base my conclusion about autism and asperger syndrome based on the current litterature on autism perception and cognition.

My view about autism is in line with the view of a research group which I worked for and conclude that autism is a phenotype of the human brain. It stand to reason that autism is a disability because it’s not the most prominent brain phenotype (which is neurotypical) and we need to accomodate the disability of autistic (& asperger) people and also, of a range of other phenotypes too (all the other psychiatric or neurodevelopmental diagnoses).

You maintain that autism is caused by vaccine and underlying the autistic shell lies a neurotypical boy or girls, fine. Given what I know about biology, I maintain that it is impossible that only the neurotypical phenotype is found in 100% of the earth population and that environmental pollutant or insult (including vaccines) are responsible for autism, asperger and all the developmental disability or mental health issues. Prove me otherwise.

You know, I don’t waste a lot of my time keeping track of Six Hundred Degrees Jake, but even so, I have to point out a very relevant factor when it comes to the acceptability of questioning his diagnosis: which diagnosis!?

Correct me if I’m wrong, but my understanding of Jake’s history is that he was initially diagnosed with some variant of ADD/ADHD by actual medical professionals, but that subsequently Mama Crosby decided that in her expert opinion, Little Jake must have an ASD instead (and that vaccines must be responsible) and sought out an expert who “confirmed” her decision.

To take at face value the condition Jake currently claims is inherently to question the initial diagnosis, the one that was made by medical professionals without Mama’s hand on the tiller. To borrow a phrase from the courtroom dramas: “You opened that door, Counselor.”

I am unaware, however, of any comparable circumstances that would justify or render less reprehensible Jen’s suggestion that Alain’s diagnosis is incorrect or falsified. There doesn’t appear to be any logic behind it apart from a fallacious appeal to consequences: “If he’s not really autistic, then I can pretend he’s just not as invested in finding someone to blame for autism as I am.” Needless to say, that’s a poor alternative to “hmmm, someone who has just as much or more skin in the game than I do nevertheless doesn’t agree with me. Maybe I should think about what that means?”

You can go bankrupt if a tornado hits your house and destroys all your worldly possessions.
You can go bankrupt if your “hedge fund” turns out to be run by a con man (heck, the government may sue you to get any money you withdrew from the fund, even though in net you lost)
You may go bankrupt if someone sues you for injuries they suffered on your property, or near your property, or from animals that your renter keeps on your property (even if those animals are not on your property at the time and aren’t under your control)
You may have to choose between paying to replace your inoperative smoke detector and eating.

All of these things are terrible consequences I wouldn’t wish on anyone. But then, life is not fair.

So why is medical care in such a different class from everything else?

@ Antaeus Feldspar: Here’s one of Jake’s earliest articles for AoA…when he had the epiphany that he was *toxic*. He later found out that Mama Nicole knew he was *toxic* years before and was *treating* him for his toxicity. Notice how he disparages Dr. Offit somewhat. His behaviors have changed markedly over the years, because every time he stalks someone, he gets reinforcement from his groupies at AoA:

Ah, well, there we go, a difference in language usage. I’m indulging in a bit of hyperbole to make a point on a subject about which I feel strongly.

I’m not talking about personal choices here – should government be in the business of ensuring that every person has all of the safety and health advantages of every other person?

I think every American should have a basic level of care to fall back on, much as occurs in other countries. There is no reason we can’t do this beyond partisan bickering.

Resources are finite today. The difference is that those determining who gets those finite resources are the insurance companies. Why should anyone’s health care be for the profit of an industry that does nothing to make any of us better?

It’s true that life isn’t fair, but isn’t it our responsibility as civilized, intelligent creatures to try to make it fairer?

Well, yes, that’s true enough. There are many areas where this could be applied. Is it fair that some people inherit millions while others are born poor? Is it fair that some are born tall and others short?

Why is medical care, specifically, the one that so many people feel so strongly about that they declare it a basic right and demand government supply universal coverage?

@ Mephistopheles O’Brien: It’s not just an instance of going bankrupt due to medical costs. The problem arises when you have pre-existing medical conditions…which could be as *innocent* as having well-controlled HTN or being under treatment for cancer when you lose your job…or lose your spouse/partner who has the medical coverage. You only have the option to continue group health care coverage, paying the entire premium for for 18 months, beyond those losses. A highly paid employee might be able to manage to those premiums, but for others the full costs to ensure a family is prohibitive…they barely have enough money from unemployment insurance checks to put food on their table and pay for housing and utilities.

If you or your dependent has preexisting medical conditions and you have insurance…you dare not leave your job for another position. You and/or your dependent are “uninsurable” under the present system.

The *voucher system* that will be enacted to cover those under 55 years of age for Medicare Part A (hospital care), under the Republican leadership, is ludicrous. Supposedly, rules will be enacted to prevent insurance companies from cherry-picking the healthier older recipient. Is it any wonder then, why younger people who are approaching age 55 and have paid into “the system” are dissatisfied, with this “voucher” scheme?

I won’t even go into the morality of denying health care for our most vulnerable members of society…the poor…the uninsured…the uninsurable.

The suggestion that the Puritans even had a strong cultural influence on the U.S. in the first place betrays complete historical ignorance.

Really? Because a significant contingent of early US settlers were Puritans, and many of their writings were influential. Not the Founding Fathers; most notably, there is very entertaining body of work by Benjamin Franklin (much of it under a pseudonym) pillorying the Puritans. In a way, they were the Mormons of their day — ostracizing outsiders, and eventually coming under considerable political pressure to ease off their religious views so that they could be accepted into the larger community. It goes back to long before the founding of the United States — over a century before. Much of their craziness was ameliorated by the time of the Revolution (nothing can unify like a common external foe, and the Puritans were not generally Royalists), but it didn’t completely disappear. These philosophies have had a resurgence recently (though Puritanism itself is a fringe religion at best these days), possibly due in part to the rising political power of the religious fundamentalists.

Of course, I glossed over another philosophical reason to object to national health care, and one which has historically been stronger in America: libertarianism. Welfare and national health care are both seen by some as violating the right of an individual to self-determination. You stand or fall on your own merits. The ideal is that you should do it on your own or not at all. These people will also object to national health care on a taxation basis, of course, since a libertarian is usually also in favor of small government and lower (or no) taxes.

There are exceptions, of course. My late grandfather was a libertarian, and in favor of national health care. (Also in favor of euthanasia, actually. He was a really interesting person to have a conversation with, because he had strong views that you don’t always see next to one another, sound reasons for believing them, and a constant willingness to openly and respectfully argue about them.) He felt that if our government should be doing anything, it should be doing this. Of course, he was also a surgeon at a small hospital in North Dakota, then later in Montana, and this may also have had an influence on his thinking. Rangeland tends to breed people with a strong sense of independence, but a great respect for the value of a good surgeon (what with farm accidents and all).

Jen:

And surely people must realize that illness can strike anyone at some point).

Never underestimate the power of denial. People talk on the phone while driving, even though intellectually they are surely aware that car accidents can happen at any time, even to the car directly in front of them in traffic. “It won’t happen to me” or “if I do things right I can avoid it” are deceptively seductive lines of reasoning for many things in life. I’m sure that if my state didn’t require all drivers to carry collision insurance, a great many would not. (A great many *still* don’t. My brother was t-boned by one of those a number of years ago. Fortunately, a low-speed accident, but the guy not only wasn’t insured, he also wasn’t licensed, was on drugs, and lacked a visa to be in the United States. Yeah; the insurance company certainly wasn’t happy, since they couldn’t collect from this person. Can’t squeeze blood from a stone.)

I guess Canadians and Brits just don’t have that Puritan objection to making sure everyone is taken care of. I haven’t heard of ‘death panels’ but euthanasia seems to be topical lately and it does concern me. It makes me sick to think of that idiot that made sure his wife (TerrySchiavo) would be starved to death- her mother not even allowed to wet her mouth for comfort.

The Schiavo case is a complicated one, because it involves a “he said/she said”. The husband said that his wife didn’t want to be kept on life support. Her parents disagreed. Since she didn’t have a living will, there was no way to be sure of her desires on the matter, and the courts had to figure it out. This is why I think it’s so tragic that the “death panels” thing came up; the proposal was just to allow Medicare recipients to get reimbursed for getting medical advice about living wills. Every adult should have a living will. If you don’t have one, get one, and make sure all of your family knows how to access it. It’s the only way to prevent a nightmare like the Schiavo case (which, in my view, is a nightmare no matter which side you supported in the argument).

I have heard of some people going so far as to get a living will tattooed on their bodies. That might be a little extreme, but I can understand the motivation. 😉

As far as forced interventions go, right now, forced interventions are not permitted except under very narrowly defined circumstances (such as the courts ordering a person into psychiatric treatment). I don’t see that changing under Obamacare. Even insurers do not have the power to force anything. They can withhold coverage on almost any grounds, but in general, the practice is more carrot than stick. Many offer 100% or at least much superior coverage of certain preventative services, such as vaccines, prostate exams, and pap smears, on the theory that this encourages people to get these services, and this saves them money by reducing claims for vaccine-preventable diseases and advanced cancers. Mileage varies widly, though, and insurers are still free to set the premiums the way they want, which could theoretically include increasing premiums for the unvaccinated (and especially for those with a medical reason, since that would be a pre-existing condition, something some insurers will use as an excuse to charge more for).

But. The conspiracy theorists tend not to stop with what’s real and get on to the hypothetical. Much as the opponents of gay marriage in my state are claiming that if we don’t amend our state consitution to define marriage as 1 man + 1 woman, religious institutions will raided and small businesses fined (for no readily apparent reason), opponents of universal health care often claim that dire consequences will befall us if the government gets any more involved in health care. They don’t usually bring up forced vaccination, but perhaps that’s because they really go for the jugular — death panels to decide who lives and who dies, forced abortions, forced sterilization, forced medication with psychoactive drugs….these are the specters they tend to invoke. And they’re no more real than the forced vaccination. As you say, Health Canada certainly doesn’t have any of these problems. Neither does the NHS, nor any system I’m aware of. Now, China rather famously *does* have forced abortion, and they also have a national healthcare system, but their system is . . . deficient would be putting it nicely. And the abortions aren’t forced by the healthcare system but by their notoriously draconian penal system.

Of course, there is the fact that the US is number two in the world for executions and number one for the size of the prison population in relation to the size of the overall population. This probably helps give the conspiracy theory some legs.

There are many areas where this could be applied. Is it fair that some people inherit millions while others are born poor? Is it fair that some are born tall and others short? Why is medical care, specifically, the one that so many people feel so strongly about that they declare it a basic right and demand government supply universal coverage?

I believe that this should be applied in those areas as well. I support the redistribution of wealth and the provision of free stilts for short people, so I’m probably not the best person to answer your question. Perhaps it’s because suffering ill-health and dying unnecessarily is a little different to being poor instead of being rich, or being short instead of tall.

In the end I think it all comes down to aesthetics. It disgusts me that a wealthy nation has some people dying due to a lack of basic medical care, while others have more money than they could spend in a hundred lifetimes. I don’t like stepping over homeless people on my way to the supermarket, or the fact that half the planet lives in relative luxury while the other half struggles to survive. I try to do my own little bit to redress those inequalities.

Is the following really too radical?

Everyone has the right to a standard of living adequate for the health and well-being of himself and of his family, including food, clothing, housing and medical care and necessary social services, and the right to security in the event of unemployment, sickness, disability, widowhood, old age or other lack of livelihood in circumstances beyond his control.

I entirely agree with you, I’m writing from the perspective of someone who has lived all his life with universal healthcare and supports it wholeheartedly. I was just pointing out that with or without universal healthcare, hard decisions about allocation of resources do have to be made.

Mephistopheles: Do you realize that even getting *basic* preventative health care is impossible for a lot of people in the country? How is it in the country’s best interest if people have to choose between vaccines and food? Or someone misses a doctor’s appointment- and dies of undiagnosed appendicitis?
Let’s say that one parent is working and the other isn’t, and the working parent gets appendicitis. Unfortunately, there’s no insurance, and the working parent dies. Non-working parent and kids have to go on food stamps. Wouldn’t it simply be easier-and perhaps cheaper- to have prevented that death in the first place?
And keep in mind, that if health insurance was at the rate it is now, I wouldn’t have my dad, and none of us kids would’ve been able to go to college.
Also, Mephistopheles, are you in favor of privatizing the police force or the fire department? Why or why not? After all, they’re both in the business of preventing death, are run by the government, and are basic services. So, if health insurance shouldn’t be supplied by the government, aren’t police services and fire departments unneccessary as well? Heck, what about public education?

Krebiozen – re: rights. Let’s assume we agree those are perfectly reasonable rights, just like the right to free speech or the right to worship (or not) as you choose. You have the right to an adequate standard of living – does that mean that others have the obligation to provide it? Do others have the obligation to provide your soapbox on Speaker’s Corner? Do others have the obligation to provide your church and your transportation to it?

Or is it “from each according to his ability, to each according to his needs?”

Politicalguineapig – you’r speaking now in terms of utility and cost benefit, something that can certainly be debated.

I do not favor a private police force because I believe it can be reasonably shown that a public police force provides a substantial benefit for the society as a whole. I also believe that (well known cases to the contrary) private police forces are more likely to be used in abusive ways. I have no particular thoughts on private fire fighting companies – I would expect they could do a fine job, but have no issue with our current fire departments. They provide an important benefit not only to the people who own buildings that catch on fire, but to those who have nearby buildings. The history of cities burning down suggests that good fire departments – publicly run or privately run – are indeed useful.

What about private ambulance services? There are many cities that do not have municipal ambulances and use private companies for that. Is that a basic service the government should provide?

Why is health care such a basic service that the government should/must supply?

Lest I be misunderstood – I have no strong opinions about universal health care. What I’m trying to explore is why people couch this in terms of morality, fundamental (inalienable?) rights, barbarism, criminality, and so on. It may well be a good idea; it’s certainly a compassionate thing to do that would benefit many – at a cost. Why is it immoral, criminal, or barbaric to state otherwise?

Really? Because a significant contingent of early US settlers were Puritans, and many of their writings were influential.

You’re right; I let my irritation get the better of me. What I was mainly thinking about was the highly exclusionary character of the movement and its prompt splintering thanks to the same sort of squabbling that made them a pain in the tokhes in Dutch exile. That, and that the Great Migration wasn’t that great.

I will give them the promotion of education for the sake of literacy; as for Max Weber’s take, I’m not so sure.

The morality of universal health care is debatable. I think the point of a government is to address inequities of various kinds. People cannot be expected to come to the defense of our nation effectively, so we field an army to do that job. Private roads are of limited effectiveness; a turnpike will only go where and as far as its owner feels inclined, and probably won’t serve areas that aren’t profitable for it, so our government steps in and builds and maintains roads for us. Communities which can’t afford decent schools get state funding, which includes money from wealthier areas, ensuring that poorer communities have a shot at a decent education. Private law enforcement is pretty much insane, since of course they will have their employer’s interests at heart rather than the community’s, so government takes care of that too, as well as the establishment of a judiciary and a penal system.

Should health care be added to that? Should we make it the responsibility of our government to make sure everyone has at least some minimum standard of health care?

I think it would be beneficial. How much is our GDP affected by reduced productivity of sick or injured workers? How much welfare spending is needed only because of preventable disability? How much less money would Medicare need to spend if people stayed in better health before they qualified for Medicare, by getting their conditions detected and treated earlier? And how much money would it save the rest of us, those of us who are currently insured, by making hospital care less expensive? Universal health care would reduce the cost of health care, by removing the massive drain of minor conditions being treated in the ER because it’s the only option for too many folks.

Honestly, even ignoring the moral question, I think universal health care, or at least single-payer health care, makes sense for our government. Not because it’s the right thing to do, but because it would save money and improve our nation’s productivity.

I worked as a public health nurse. I worked, and I still reside in a County, which has diverse populations . We cared for people in our seven satellite clinics who were uninsured, underinsured, on Medicaid and who were undocumented immigrants. I felt then, and still feel, that we provided a medical home for these patients. Many of the patients came to us for aftercare after they had been treated in our County hospital. No one was ever turned away.

Isn’t it a good thing, that our County hospital and County public health clinics provided preventive health care and ongoing health care for pregnant women, young babies and older people, who were uninsured? Isn’t it far better to provide immunizations and to treat emerging health problems, in their early stages, instead of hospitalizing people for advanced cancers, diabetes, and cardiac problems?

Why should little kids be put at risk for vaccine-preventable diseases and for untreated asthma, because their parents are uninsured?

What about the *silent killers* (elevated blood glucose levels, hypertension and hyperlipidemia) that go undiagnosed and untreated due to lack of insurance? Do we as a society want people to go into major organ failure or lose their eyesight due to undiagnosed and untreated glaucoma, because they lack insurance?

I have familial hypercholesterolemia, and because I had medical insurance my condition was monitored…but untreatable. I was enrolled in one of the early Lipitor trials by my private physician. When the trial was unblinded, my cholesterol level was 180 mg/dl…down from 400 mg/dl. What would my health status be today, if I didn’t have insurance coverage?

I’ve had medical coverage for my entire life and eternally grateful that I was able to provide that coverage for my children. I was able to afford the extraordinary costs associated with my disabled son’s medical care, that were not covered by my medical insurance. I also have great empathy for those who are uninsured and underinsured, because I know only too well the devastating consequences of not having coverage for preventive care…for diagnosing of diseases and disorders in their early stages…before they become life-threatening/incurable.

Yes, we have finite resources.

Yes, we should stop playing international cop and look to cut our military budget.

Yes, we should try to educate people about the limits of medicine (“If we can put a man on the moon…why can’t we cure cancer?”).

Yes, we shouldn’t have Sarah Palin who panders to ignorant oldsters, by labeling counseling by your physician about end of life care as “death panels”.

Let’s assume we agree those are perfectly reasonable rights, just like the right to free speech or the right to worship (or not) as you choose. You have the right to an adequate standard of living – does that mean that others have the obligation to provide it?

If they are able to, yes, “in the event of unemployment, sickness, disability, widowhood, old age or other lack of livelihood in circumstances beyond his control”. I have always been very happy for some of the taxes I pay being used to help others in need, with the knowledge that I have the same safety net should I ever need it. I’m happy to vote for a political party that supports such a system

Do others have the obligation to provide your soapbox on Speaker’s Corner? Do others have the obligation to provide your church and your transportation to it?

Of course not. Is that a slippery slope argument? I don’t think I’ve ever seen anyone suggest such a thing. There is a huge difference between providing someone the basic essentials of life, and providing them a soapbox to preach from or a church to worship at.

Or is it “from each according to his ability, to each according to his needs?”

That has always seemed a perfectly reasonable maxim to me. Of course when Marx coined that phrase he was positing a utopian future in which there were enough resources available to provide for everyone’s basic needs; a bit like the present really. I do understand that many Americans tend to get a little excited by any suggestion of communism or indeed socialism, but I don’t really understand why.

Maybe I should explain my position a bit further. I consider than in any transaction in which one party makes a profit, the other party by definition makes a loss. This means that the rich do not “make” money, they find ways of persuading some people to sell their labor for less than it is worth and/or other people to buy goods or services for more than they are worth. The word “entrepreneur” literally means “between-taker”, that is a person who makes a profit by buying from one person at one price, selling to another at a higher price and pocketing the difference – isn’t getting rich that way that pretty much The American Dream? It is IMO glorified theft in a system enforced, ultimately, out of the barrel of a gun.

Requiring those who have stolen the money of the poor to give a little back to provide for those worse off than them doesn’t seem too outrageous to me. Refusing to do so while they suffer and die as a result does seem barbaric to me.

I do understand that I have a somewhat unusual attitude and I don’t expect anyone to agree with me.

Mephistopheles: Basically, health care should be provided by the government because the government benefits from a healthier populace. It’s the same as public education: most democratic governments need educated citizens. (Major reason I believe the US will revert to facism in my lifetime.)

While religious/private services are an option, would anyone trust a private fire-fighting company? Or an ambulance that required bribes before treating anyone? And I’m not even going to go into the problems with hospitals run by churches.

Something else to consider–a lot of conservatives seem to have the strange idea that in the absence of UHC they won’t be required to contribute to the cost of providing healthcare for those lacking insurance, sufficient private resources, etc. It’s a myth: we’re all doing so, just inefficiently, in the form of increased insurance premiums, higher hospital and doctors’ fees, lower productivity as a nation, etc.
Regardless of whether or not one has a fundamental right to health care, it makes economic sense to adopt a system like the UK’s, which delivers equivalent (or in some instances superior) care for a smaller per capita outlay.

Politicalguineapig – People certainly have dealt with private ambulances and fire fighters. They’ve also dealt with private garbagemen, private telephone companies, private power companies, private water companies, and various other “basic services”. Sometimes governments contract with these vendors, allowing for local monopolies; sometimes they regulate multiple vendors and let them compete for business. As a trivial example, I have a choice of two different garbage haulers where I live.

Why would you think a private ambulance company would necessarily take bribes?

Let’s talk food for a second. There are no government run grocery stores or restaurants where I live. I know of government run liquor stores in another state, but I guess that would be a government run basic service. I can go to a choice of large and small vendors, even to individual farmers. I generally trust them.

I agree there could be benefits from universal coverage, run by the government. Will you agree, on the other hand, that being government run is no guarantee of quality, efficiency, or cost effectiveness?

Politicalguineapig — ambulances requiring bribes: see also, Romania. Although they ostensibly have national health care, in practice the system is so corrupt that bribery is normal practice almost everywhere. You have to pay to have your sheets changed at the hospital. Under the table, of course, since bribery is illegal (but universal). Unfortunately, a national health care system will tend to reflect the government which produces it. If bribery is socially acceptable, and the government declines to adequately fund the system, then bribery is inevitable.

As a Canadian I will freely admit to a bias in favour of a publicly-funded healthcare system – there are certainly things about the Canadian system I would improve, but on the whole it works. The main failure I see in the US system is the expense – the health outcomes are roughly the same as other industrialized countries, but Americans are paying far more for care and for too many people the costs are economically ruinous. Other people up the thread have noted that the government ends up paying anyway for the results of this situation – from both a practical and moral standpoint, doesn’t it make more sense to provide basic health care coverage for everyone?

Mephistopheles: Sure, and some of those private companies have worked out, and a lot more of those companies haven’t. Google Bolivia and ‘private water companies’ sometime to see how wrong things can go.

What makes you think privately run ambulances wouldn’t take bribes? Also, why would you think that they would be willing to treat everyone? I already have to keep an eagle eye on any pharmacists I interact with when I try to pick up a certain prescription. If I see a cross around their necks, I will not be sticking around. If I have to consult a doctor and she has any visible religious symbols on her person or in her office, I will probably not return, since I would probably receive sub-par treatment at best.

I’d agree that there is no guarantee that a government run agency will be efficient or cost-effective. But you’re completely ignoring the fact that private agencies have no obligation to be efficient or cost-effective either. Heck, ethics are a hindrance in the private sector.

I am entirely intrigued by your statement concerning the pharmacist’s/ doctor’s religion as expressed by religious symbols**:
has anyone ever treated you unprofessionally by introjecting his or her own beliefs into your treatment plan,
behaving scornfully or judgmentally ( I’m assuming re contraception) OR
are your worries more influenced by widespread conservative Christianity in your local area? Others’ experiences? Perhaps in effect, a prevalent anti-feminism?

At any rate, I have personally only lived in extremely liberal areas so I have no idea- but really, it sounds awful.

** I sometimes wear a silver charm (from a museum of archeology) that is an octagonal shield with a central cross within a circle: my Irish friend asked, “Is that Anglican or Witch?”
-btw- she knows I’m atheist.

It will be three years next week since the NHS put me and DH back together after a terrible RTA while we were beginning out honeymoon. The surgery, hospital stay, aftercare (including home visits from nurses and physio therapists) didn’t cost us a penny. I am so grateful for our NHS though, yes, it is a bit creaky and is used a political tool far too often.
@Politalguineapig
Even within a system like the NHS there is room for judgemental dispensing practices, unfortunately http://news.bbc.co.uk/1/hi/uk/8586344.stm

Let’s talk food for a second. There are no government run grocery stores or restaurants where I live. I know of government run liquor stores in another state, but I guess that would be a government run basic service.

You obviously do not live on a military base with a commissary or post/base exchange. By the way, to go on Narad’s comment, they do accept food stamps. The lowest of the low of the enlisted personnel are not paid enough to support a spouse and family that many actually have (like my high school classmates who were Army wives, very young persons). At least they have medical benefits (and even it has limitations).

By the way military commissaries are strange places. The last time I shopped in one was when I was in college and still had my dependent ID. There arrows painted on the floor to show the direction one must go down the aisle. I actually did not find it odd. That was over thirty years, and that particular building was torn down when the Navy base was turned into a city park.

DW: No, I haven’t actually experienced any discrimination about contraception. I have encountered one rather snotty physician- I might be fat, but I am aware that veggies exist and I like them.

I do spend a lot more time then I should on the internet, and I spent a lot of that time hanging around feminist blogs. I’m currently avoiding them because they make my anxiety level shoot up. Because of them, it’s hard to shake the idea that ob/gyns are either fundamentalists or perverts. And I suspect most pharmacists as being closet fundamentalists until proven not.

I live in a fairly liberal area- in my particular neck of the woods, it’s mainly old hippies, hipsters and Somalis.
Because of the locations of the various music clubs, the latter two often cross paths.(“Street blocked off again-another music festival.” In October, “mommy, why are all the white people bloody?”) Thankfully, they’re quiet and get on with their lives-unlike freakin All you need to know about it is that it’s where Rep. Bachman got her start. I could go into details, but that would probably be a dozen blog posts, and this ain’t my blog.

There arrows painted on the floor to show the direction one must go down the aisle.

Ah, you remind me of one time when I was maybe seven years old and, on a trip, my uncle took us to a Norfolk PX. I thought it was even cooler than the employees’ store at the Sears, Roebuck Merchandise Building (which was larger), where my grandmother long worked.

OOoooh, me! Me! Though this may be beyond anti-feminism.
I grew up in and remained in the South (y’all) until a few years ago.

When I developing terrible menstrual cramps out of the blue (I’d never had cramps before, thought girls made them up to get out of gym), my GP was concerned and referred me to an OB-GYN. This was supposed to be a really good OB-GYN.

Doc did the exam and asked me questions. Upon learning that at the ripe old age of 25 I was unmarried and didn’t have children, the doctor said that I should get married and have a baby because “Having a baby would cure the problem.” And then, I kid you not, he went on to say that a pretty girl like me shouldn’t have a problem finding a nice husband.

@OT – sounds like he certainly deserved it. I have a hard time talking with my Dad (when we do talk – once in a blue moon) in Tennessee, because he has gone so far to the right in his thinking about everything (believes Rush’s word is God & such nonsense).

There are areas of this country that seem to really want to pull things back into the 19th Century.

Politicalguineapig — I’m not sure I see the point of choosing a doctor based on their belief system (or lack thereof). Believer = knuckle-dragging bigoted loon was laid to rest during the discussion on battlefield acupuncture, I thought.

(My primary care physician is a Christian, my opthalmologist is Hindu. Haven’t noticed that their religious beliefs make them sub-par practitioners).

Shay: A man (which I assume you are) would get completely unbiased care. Oddly, Christianity doesn’t have a problem with viagra, vasectomies, or urological procedures. After all, according to the Abrahamic religions, men are people and women are just..jars. As for eyes- there’s yet to be a religion that has a problem with vision. Or, if there has, it died out.

As for the stereotype of believers- I’ll start treating believers as intelligent people when they start acting like it as a whole. Until then, I’ll treat them as loons until proven otherwise.

You kind of remind me of some of the senior (male) officers I worked for on active duty (few, thankfully) who automatically assumed that since I belonged to a large and very visible demographic that I must not know what I was doing. It got kind of annoying, having to prove myself just because I was a woman.

Given the highly diverse population with which I work, I can’t afford to be that judgmental. You walk in, I check your creds, you’re ok with me.

Just was on the phone with a push-poll about “Obamacare” and a big emphasis on US budget costs & deficits. On the basis of the wording of the questions, I think the poll was from the Karl Rove crowd. It was recorded for quality control or something and they took my name. There were loaded yes/no questions so I went on & on in some detail & I kept it clean but I suspect I was a bit intense. I know I was. Of course I got off topic. Asked if I was satisfied with O-care, I pointed out it that the health care system could be much better reformed but the right-wing offers nothing.
In my rattlings I emphasized, among other things, the importance of science education, basic science infrastructure, investment in science, that sort of thing. I’m sure she thought I was off the rails when I pointed out the the Republican attitude toward science is unpatriotic. (for those who take issue, I maintain that reality is patriotic) I ended by urging the nice but probably frustrated young woman (by voice) to become more educated in scientific matters. I described myself as a moderate.

I am aware of many Americans being nervous of “Obamacare” in that if they don’t accept certain interventions- prescriptions, vaccines etc. then services will be denied them.

Unlike (nearly?) anyone else here, I’ve actually read the Affordable Care Act. There is nothing – absolutely nothing – in it about “forced interventions,” much less about denial of services contingent on such. This does not even rise to the level of being one of the popular wrongheaded delusions about ObamaCare. It is very definitely a fringe wrongheaded delusion. Just who are your parents hanging out with?

And about Terry Schiavo – Have you ever been in the terribly sad and stressful position of having to make end-of-life decisions about a loved one? If you have, then imagine the entire Canadian Parliament trying to horn in on that decision, and happily bringing down a rain of reporters and public invective on you as well. And you’re the one who supposedly objects to forced government interventions?

Shay and lilady: You two are in the ‘proven otherwise’ category.I apologize for any offense. As I may have mentioned in another thread, I tend to categorize people in order to figure out how I should interact with them. I admit, I sometimes miscategorize people (most of my friends are in demographics I wouldn’t interact with except for the accident of education.) Since I’m not good at people, I haven’t seen much reason to scrap the catalog system.

@ politicalguineapig: I *know* you didn’t mean to offend any religion or the male gender.

Most of my doctors are males…it just worked out that way…including my GYN. (Both babies wee delivered by male OBs).

When my son was release from the NICU at 10 weeks old, we had nurses who visited each day…some were nuns.

His first PT, Sister Helen, who was a nun-registered nurse-physical therapist, taught me in my home to do passive-range-of-motion and other therapies. She became one of my dearest friends…and she was a feisty lady…just like me. When my husband was around, we would duck out the door to have cigarettes and some glasses of wine. She went with us to a fundraiser at my son’s early intervention program where she proceeded to dance with all of us…greater dancer.

What I am saying to you is, people are people…they are inherently good and the ones that you meet in the medical field are, with rare exception, very dedicated and caring.

@Jen: Your in-laws may be delightful people, but they are listening to the same loons who probably declare that girls only get Gardasil so they can run out and have sex all the time. Having read most of the Obamacare act (shorter to type as a title, anyway…), and yes, I *do* work in health insurance, I have not heard ANY insurer say that there will mandated vaccines, mandatory statins, whatever. The health insurance companies will be required to COVER such things, but the members who have the insurance will not be required to have them. Those members may be held liable for a higher premium, but they will not be held down and forced to accept any health care they don’t want.

I think that’s only fair. I don’t think we should have to pay for those who leech off the ones who try to stay healthy. There are those – infants, disabled, elderly, those who can’t be vaccinated for health reasons – who deserve consideration. But those who can and don’t should have to pay more to cover in case they need treatment for preventable illnesses.

I would be no happier for my own healthy child to avoid preventative healthcare and leech off the group (fortunately, that isn’t a concern; they both are very conscientious about maintaining good health care practices, vaccines up to date, etc).

I never said they wouldn’t. You said “Or an ambulance that required bribes before treating anyone?” Where’s your evidence that they would require bribes (outside of locations where bribery is endemic, as Calli Arcale properly points out)?

Private ambulance firms that I’m aware of do charge a fee. You can either get insurance for that ambulance service or be prepared to pay.

You’re correct, it’s been a long time since I’ve been in a commissary, exchange, galley, or mess.

You’ll note that medical benefits that go to our armed forces are provided as part of their total compensation for employment . They are quite generous by non-military standard, and rightly so. We ask the members of the armed forces to do very dangerous work with a much higher likelihood of illness or injury than expected of an overwhelming majority of those privately employed.

Shay and lilady: You two are in the ‘proven otherwise’ category.I apologize for any offense. As I may have mentioned in another thread, I tend to categorize people in order to figure out how I should interact with them. I admit, I sometimes miscategorize people (most of my friends are in demographics I wouldn’t interact with except for the accident of education.) Since I’m not good at people, I haven’t seen much reason to scrap the catalog system.

Have you ever thought that perhaps “the catalog system” is part of what makes you bad at people?

First of all, gross descriptors such as “male” or “religious person” rarely give you any real information about who that person is.

Second of all, when you place someone in a role, they often pick up on that and respond to that role. If you jump to the conclusion “this is someone who’s probably because of their sex/race/religion going to be unfriendly to me” then guess what, they’re likely to be unfriendly to you because you’ve already slotted them into that role.

Thirdly, ever hear of confirmation bias? Maybe you’ve run into someone who a) doesn’t match the expectation you have of them based on their “category”, and b) doesn’t succumb to the pressure you’re putting on them to fulfill the “role” you expect. But because you expect them to fit into that stereotype, you don’t see who they actually are, you just see what you expect to see.

lilady: What I am saying to you is, people are people…they are inherently good and the ones that you meet in the medical field are, with rare exception, very dedicated and caring.

I deeply dispute the first half of that sentence. For some reason, you remind me very much of my aunt, another relentless sunny-side-up optimist.

Anteaus: Thing is, I know why I’m bad at people. It’s not because of the catalog system; it’s because I was really shy as a kid and smart. Naturally I had a tough few years until I figured out that the best thing I could do for myself was underachieve, be aloof and get as strong as possible.
The best thing I did for myself was cultivate a reputation as ‘the tough chick’ in high school. Oh, and learn the art of the little white lie. Everyone says ‘be yourself’ but that’s terrible advice. Even my friends don’t need to know the real me.
I’m polite to everyone. Regardless of race, ethnicity, religion or where they register on ‘are they going to bomb this place’ scale. (I work at a Science Museum, and we get a fair number of lost evangelicals.We have dinosaurs, which I’m sure rank pretty high on God’s shit list.)
And yes, I’m aware of confirmation bias.But if I give them no hint of how I expect them to act, obviously, they won’t pick up on it. On the other hand, if I go into every interaction blind, I won’t be able to execute an escape plan if things go bad.

Nice Article related to health insurance .Thanks for Sharing..I can’t understand why the Obama campaign does not constantly reference this. Are they afraid to say, “We implemented Mitt Romney’s healthcare plan” because they think Romney will embrace it as a selling point? ??????????

@ politicalguineapig: If you venture on to this blog and start with generalizing remarks about white men, people of various religions and doctors…you should be prepared to accept how commenters react and post back at you.

The discussion of ‘Obamacare’ always leads me to the popular generalisation: only in America.

From the outside, in a country with universal healthcare, I admit to being utterly unable to fathom the problems with the overall idea of having more healthcare for more people. (I will agree the details are important and done wrong, it’s useless. Nor is the system here perfect)

Oddly enough, I’ve been accused of being a ‘slave’ by a libertarian for thinking that my taxes go towards better healthcare with more freedom to choose how I receive it. I am still unable to fathom the logic behind that comment, and they weren’t inclined to explain it to me – considering that I was so much of a ‘slave’ that I couldn’t possibly change my mind even if reasons were laid out in front of me.

The strange reasoning that goes with this stuff eludes me. Especially since I have never ever worried about affording a trip to the doctor, ER, specialist, pharmacist or test facility. And I’ve done many of those things…

Actually, the weirdest thing to me is that health insurance is coupled with employment. Give me your tired, poor, hungry… and then ensure that when they get sick, they can’t get help because they’re tired, poor, hungry – and unemployed!

Having said all of that, it’s clear from Orac’s post that things are a little more complicated (as always) than they seem and that my ideology needs to be tempered with a bit more skepticism. I’m actually surprised the mortality is so ‘low’ for uninsured people. … I do love this site, it’s always teaching me something.

.. Is it me or was the Dispatch article written badly: it seemed all over the place veering from one thought to the next and then back to the first thought.

@Lilady

Thanks for posting that Lawrence O’Donnell stuff. I am in total agreement with his sentiments.

“….Actually, the weirdest thing to me is that health insurance is coupled with employment. Give me your tired, poor, hungry… and then ensure that when they get sick, they can’t get help because they’re tired, poor, hungry – and unemployed!…”

Flip: I think the low mortality rate might be because a lot of uninsured people are in their twenties. Sis knows a lot of people without health insurance, and I know a few too- since a lot of people our age work low-paying jobs without benefits, or they forgo the insurance entirely.

Mephistopheles: Again, ETHICS ARE A LIABILITY IN THE PRIVATE SECTOR. Of course privately run ambulances will take bribes, since there’s no rule against it. Another thing; what happens if someone strays into an area where there are only privately run ambulances, has no insurance, no cash, and has a seizure,an insulin crash or an anaphylatic attack? Obviously, they’ll die on the street. I think we can both agree this isn’t a good thing, right?

I am what most in the US would consider a rabid lefty. I don’t think I’ve ever voted for either of the two main parties in my life. — Council elections generally don’t present info on party affiliation, but you can usually look it up or work it out from what they say about themselves on the forms.

Funnily enough, the more I read of science blogs and other things, the more I realise I’m probably centrist in a lot of areas, if not right-wing in others. But then, the right-wing party of my country – Australia – likes the ideas of putting bibles in the hands of school children. Compulsorily. On the other hand, our atheist female Prime Minister doesn’t want to introduce gay marriage despite the majority of voters wanting it. … Sigh… And this is why I vote third party.

That kind of makes sense, except it almost seems too simplistic to be true. But then I’ve never paid attention to mortality stats for countries with UHC, so I’ve never had anything to compare it to. I guess in my head, I just always expected it to be high – and when confronted with real stats was surprised.

(By the way to anyone who is still here, am I wrong in feeling like Sid is going to turn up at any moment?)

Politicalguineapig – you’ve obviously had no particular dealings with the private sector and have filtered that through collectivist dogma.

Businesses DO have ethics. They spend a great deal of time training people on ethics. They have to have ethics as a matter of self defense, as well as having them imposed from without. Were business truly to act completely unethically, they would not only likely fall afoul of existing laws and regulations, but would also likely inspire new regulations. Customers have little patience with totally unethical companies as well, if they have a choice (and in most cases they do).

Your amusing vision of how private ambulance companies work is a case in point. First, it IS illegal for them to take bribes – otherwise it wouldn’t be a bribe, now, would it? If they were found doing such a thing in the areas I’m aware of, there would be a substantial outcry and a reckoning. Just because they’re private doesn’t mean they’re unregulated. Also, they don’t demand cash up front – they send you a bill.

As far as I know, cities in the United States have municipal ambulance corps. All the costs to operate those ambulances, (purchase and maintenance of ambulances, supplies and paid EMTs) are borne by the taxpayer through property taxes, local sales taxes and, in NYC, Income Taxes).

Suburban areas often have “volunteer” (non-paid), firefighters/EMTs aboard their firefighting equipment and well-equipped ambulances. Costs associated with firefighting, rescue and ambulance services are paid for by property taxes and local sales taxes.

My son frequently was transported via these “volunteer” ambulances. I never received a bill and no bill for these services was ever sent to my insurance company.

Large teaching/tertiary care hospitals have their own ambulances for transferring patients between hospitals and for transferring a patient to a rehab center/nursing home. Specialty tertiary care hospitals have “mobile ICU ambulances” staffed with physicians and nurses. The patient/patient’s medical insurance company will be billed for these ambulance services.

I required the use of a private ambulance to transport my son from the hospital to my home when he was encased in a hip spica cast for a supracondylar fractured right femur. After five weeks in the cast he was transferred on a gurney to and from his orthopedist’s office for X-rays and a consultation. After 10 weeks in the hip spica cast, he again was transferred via private ambulance to the hospital for cast removal and to start rehabilitation. The private ambulance costs were billed to me and my private insurance company.

People who are wheelchair-bound do use ambulettes for non-emergency hospital visits and for trips to physicians for care. Ambulette services are a “covered” medical necessity.

There is a small subset of patients who “abuse” municipal and volunteer ambulances…for non-emergency trips to hospital emergency rooms. The municipal and volunteer ambulances will take you to the hospital, but will bill you for those trips. Those people should not take advantage of these services for their “convenience”, because it may result in delays for medical care for patients with serious medical problems.

I never heard of any ambulance staff who expected a bribe or demanded a bribe, to transport a patient.

Flip: I probably *have* oversimplified it. I suspect that twentysomethings aren’t all of the uninsured; there’s bound to be a few middle-aged people who think they can scrape by until the next job or until they retire. And a few families that are entirely uninsured too.

Mephistopheles: Look, dude, I read the newspapers all the time. From Blackwater to Lehman Bros to Solyndra and Enron, ethics are pretty lacking all across the spectrum of industries; I don’t need anyone else to point out what I see with my own two eyes.

I cited the case of someone dying on the streets because that’s what would happen, Mr. Randroid. Heck, in my state, we just had to shut down an overzealous accounting firm that was visiting people in the hospital and demanding money. I suppose you approve of that too.

I am by no means a collectivist: Communism is good theory but bad practice, and people aren’t naturally cooperative. In my political leanings, I’m actually a monarchist. Hey, it’s what the people want, even if they don’t know they want it.

I’m not a monarchist. I think it’s nuts that Australians still pay tribute to an old woman in a hat who has no political power and no interest in having said power. The only time she seems to be involved in anything here lately is if her grandkids do something or if she has one of her jaunts to receive flowers and dine with politicians.

I probably *have* oversimplified it. I suspect that twentysomethings aren’t all of the uninsured; there’s bound to be a few middle-aged people who think they can scrape by until the next job or until they retire. And a few families that are entirely uninsured too.

It’s not as though there’s any particular reason to resort to what one “suspects”: 2004, 2011.

PGP, you just don’t seem to grasp an important fact: finding one, or five, or twenty, or even a hundred instances of “person/entity from category X behaving in manner Y” does not justify a generalization “people/entities from category X behave in manner Y as a rule.”

I understand how it can seem like it’s far better to have the illusion of knowledge (“ah, this person’s from England! I know that until proven otherwise they’re stuck in Victorian superstition!”) than the reality of not knowing everything that’s important to know. But I really don’t think you realize how hateful some of the things you say are, and I don’t think you have realized that your “category system” is just plain woo. It may provide an illusion of control but when it leads to hurting those around you, it can’t be justified.

“there’s bound to be a few middle-aged people who think they can scrape by until the next job or until they retire.”

No…there are a lot of non-twentysomethings without health coverage because they fall into the working poor category and they don’t “think they can scrape by.” They simply can’t afford to pay for insurance and it’s not provided by their employers under the system that is currently in place. This not a decision made lightly. They’re choosing between healthcare and rent/food/car payments and not so much gambling as resigning themselves to the inevitable.

In re: ambulance companies. While there are some private ambulance companies here, the bulk of ambulance services in this area, both rural and urban, are provided by paid or volunteer fire departments (tax-supported). Privately owned ambulance companies must abide by the regulations of their industry or face criminal charges.

Narad: Sorry, I do know I vastly oversimplified, but I’ve been sick and am still not running at full capacity. I would’ve remembered to run a google search eventually.

Mephistopheles: Sorry. At this point, my patience is wearing very thin with libertarians and righties.

Anteaus: Do you really think I’m socially inept enough to actually *say* anything like that in real life? Nope. Like I said, I’m polite. I don’t say much at all really.
Yeah, I can’t control everything in a social situation; however, I can control who I interact with (for example, using headphones and reading a book on the bus) and the level of interaction (like not looking men in the eye ever.) Heck, I can even control the level of info my friends have on me. There are three kinds of people, the winners, the losers, and the just getting by. I am not a winner, so I continually have to keep up the charade of getting by.
As for British people, it’s not so much that they’re stuck in superstition, as they’re stuck in the whole Victorian moral code. There’s a lot of that here, too.

Shay: I would have remembered that eventually. I don’t have a lot of friends outside my age group,so I was using my peers as an example.
Since I’ve lived in one city all my life (county and public ambulances mostly) I didn’t know private ambulance companies existed in the US, or that they had rules. I still maintain that public ambulances are superior, since they have to treat everyone, and private ambulances can pick and choose.

As for British people, it’s not so much that they’re stuck in superstition, as they’re stuck in the whole Victorian moral code.

You are stuffing an entire nation into a one-size-fits-all category.

I didn’t know that private ambulance companies existed in the US, or that they had rules.

Dammit, kid, EVERY industry has rules! And in most localities ambulances are sent out from a central dispatcher who will usually contact the closest ambulance service to the address of the person requesting help, be that service public or private.

Anteaus: Do you really think I’m socially inept enough to actually *say* anything like that in real life? Nope. Like I said, I’m polite. I don’t say much at all really.

I think you’re socially inept enough not to realize that talking to us is real life. I think you’re socially inept enough not to realize that to pretend you are treating someone as an individual and inwardly condemn them because they belong to a “high-risk category” in your “system” is not “polite” any more than manure with candy sprinkles on it becomes “candy.”

Alain: Officially speaking, I have ADHD, an anxiety disorder, and some depressive tendencies. I share a lot of similiarites with a couple of friends who have Aspergers, but I’ve never been diagnosed as such. I have been considering being screened for it.
Shay: I know every industry has rules, but compliance is always an issue.
Anteaus: I think this is a generational thing. Despite how much I use social networks, I don’t see them as ‘real life.’ Real life is meatspace only, and I present quite a different personality there then I do on the net.
Again, how are they going to know? They can’t see inside my head, and I am quite good at acting.

As for British people, it’s not so much that they’re stuck in superstition, as they’re stuck in the whole Victorian moral code.

I barely escaped losing a keyboard to a mouthful of tea there. Good grief, have you been to Britain? If not, how did you come to this extraordinary conclusion? Do you think we all wear top hats and talk like Jeeves and Wooster?

Here are a few more facts about Britain and British people that might change your mind.

In the UK, 47% of children are born to unmarried parents, a ten-fold increase over the past 100 years, and the divorce rate has increased 170 fold. Over a quarter of British women had sex before the age of 16, according to the Health Survey for England. About 10% of the adult population is cohabiting, with about 40% being married.

Somewhere between 10% and 15% of people in the UK attend church regularly (compared to 43% in the US), though among my friends the only ones who go to church other than for weddings and funerals are African or from the Caribbean, or Muslims who attend a mosque.

Tolerance of crime is hard to measure, but in the UK 154 per 100,000 of the population is in prison, compared with 96 per 100,000 in France (though someone convicted of a crime is 7 times more likely to go to prison than in the UK) and 754 per 100,000 in the USA.

We Brits may still be a bit reserved and many of us seem to require large amounts of alcohol before we feel comfortable expressing our feelings, but the Victorian moral code became terminally ill during the Edwardian era, and died and was buried during WW2, 60 years ago.

I hope you don’t think that I’m overstepping any boundaries here- so pardon me in advance:

people- all people- use ( unconsciously) the characteristics of how memory itself works to abstract and categorise, developing rules about how the world works – including how people behave, think and interact ( Social Cognition). Usually this decreases the amount of information they need to manage. Stereotyping is one of these short cuts and it is one of the cognitive traps we can fall into – we also “fool ourselves” as the late, great physicist once said. It is perhaps a natural ability that we possess.

If you limit your exposure to people you might not learn that there are exceptions and complications to these rules. A psychologist phoned hotels ( Allport, long ago) about whether or not they would accept Chinese guests- most said no. When the experimenter later visited in person with the Chinese visitors, reactions were quite different.

One of the problems with anxiety is that if there is a constant, discernible level that is uncomfortable, a person will attempt to find ways of avoiding experiencing more of it and thus suffering more. Some of the ways to self-protect ourselves limit exposure to others socially as well as physicallyy. Obviously, this will assist you by reducing anxiety but it also limits your experiences and social contacts. As you probably already know, anxiety and depression are intrinsically linked together in a nasty little dance. So by staying away from the dance, you miss a lot of the music.

Belief systems -including religions,spiritualism , even woo- are also ways that people use to soften the blow of mortality, the diificulties of life and to give people a handle on controlling uncertainty about themselves and others. I could go on. Probably for weeks, but you don’t want that.

I view social networks and virtual interaction as being real: as in face-to-face interaction, we can pick and choose what we reveal to others. Maybe we can try on different aspects of our selves like we do in a clothing store’s dressing-room before we ‘purchase’ what we like most. I think that we all have a variety of suits that we wear, based on the occasion. More socially relaxed individuals have an easier time of it- social adroitness might involve costume changes.

Basically, we’re all in the same boat: using what we think and how we think- especially about other people’s thinking ( recursive thought)- to relieve our common woes.

I think that you have possibilities and shouldn’t sell yourself short: maybe your personality on the net is closer to your real one- you aren’t afraid to say what you mean and stand by your beliefs. That’s a step in the right direction.

We’re all works in progress. By alligning yourself with reality-based thinking you’ll find that you may have more allies that you think- although they may not agree with you on other issues.

A real-life example:
I come from a family with agnostic/ atheistic beliefs going back more than 100 years: one of my best friends is a Catholic , who goes to church and prays. I am not sure how much of that is attributable to up-bringing ( Ireland), her own personality or the fact that she lost a close family member to terrorism – which has truly shaped the course of her life over the past 35 years or so.

For some reason we understand each other, even though our votes might cancel each other out.

None of those ‘most promiscuous’ countries should really hand their heads in shame too much because it may reflect enlightened attitudes about women..
We women are equally self- assured enough to sleep around as much as men.

And about that alcohol thing:
one of my ancestors created a very special product to deal with social anxiety- gin. He sold a recipe to a large company, making money which he invested wisely in other relatives’ projects.
One of my aunts married a poor relation of a famous Irish whiskey maker and my cousin married a poor relation of a famous American pharmaceutical producer.
So we’ve done our part.

Supposedly we’re not the only animal that sefl-medicates- I expect you’ve run into that..I don’t have the references here now.

lilady – I’ve made the points I care to make to PGP, it’s clear she doesn’t agree, and that’s OK.

And for what it’s worth, the cities of Tulsa and Oklahoma City contract with a private, not for profit firm to provide ambulance services. A board appointed by the govenrments of those cities oversees the operations. See http://www.emsaonline.com. I’m not sure if this falls in to your description or not.

Enough about me, back to health insurance. I submit the following ideas for your consideration: that we’ve tried the private sector approach, and it’s failed.
That a government run health care system is often (and almost always) superior to the private sector health care system, and finally that it’s never going to work in the US because we’re too diverse. Note that all the countries where government health care systems work are mono-culture. Discuss.

I’d wager that a government regulated health care system would work. There is a few countries having private run hospital & insurance but everyone has a choice of government run health insurance or insurance from the private sector.

How is America more diverse than European countries or Australia/New Zealand? Those countries have immigrant populations, Indigenous populations, etc etc.

In fact, one reason I suspect the naturopath exists at my local pharmacy is because I also live in a highly Asian-populated area. There is no end of woo here; private and public health insurance; and no end of high-quality SBM as well.

… Discussing differences of point of view is nice and all, but do your statements come with evidence? Saying the north is different to the south is like saying chalk is different to cheese. Both are true, but not entirely relevant to implementation of universal health services. Equality is equality no matter where you live.

We women are equally self- assured enough to sleep around as much as men.

I’m sure that’s true, though being physically smaller and more easily intimidated they are also prone to coercion. I also think that promiscuity, like drug abuse, may be a symptom of misery and a lack of self-respect, and in the UK is often the result of excessive alcohol and or drug consumption, sadly.

Supposedly we’re not the only animal that sefl-medicates- I expect you’ve run into that..I don’t have the references here now.

I have seen it argued that recreational drug use of some sort is a human universal, and if you include nicotine, caffeine and betel nut that’s probably not far from the truth, though I have come across some people who won’t even consume caffeine.

Incidentally I was in an Indian store today and browsed through the large selection of betel nut and ready-made paan (betel mixed with lime and spices) they had. I got to enjoy chewing betel for a few weeks in India – I noticed a mild but quite pleasant effect from it, though it does have serious long-term health effects so is best avoided. It is used by hundreds of millions of people in Asia, and many die from their habit.

As for animals, many like to get drunk on naturally fermented fruit. As Narad mentioned reindeer are very keen on fly agaric mushrooms (I could digress into a discussion of urine-drinking, soma and the popularity of urinopathy in India). Then you have cats getting high on catnip and valerian, squirrels and others eating cigarette butts, monkey smoking cigarettes and probably other examples of animal drug use I have forgotten.

Then you have the experiments on rats and other animals hooked up to various drugs with an iv infusion and a lever they can push to self-administer a dose. If allowed unlimited access to the drug they will keep self-administering drugs like cocaine and amphetamines, but not so much opiates, curiously, until they die.

On the non-psychoactive drug front, again IIIRC, I think some other higher primates eat plants that kill intestinal parasites, and maybe even rub themselves with leaves that repel fleas and lice.

Note that all the countries where government health care systems work are mono-culture. Discuss.

The London borough in the UK where I live has a population of 240,000 people. They are 38% White British, 30% South Asian, 17% Black (African or Caribbean), 5% White Other (mainly Eastern European), 2% Chinese and 1% Irish. It’s not a monoculture at all, quite the opposite, but the government healthcare system here generally works OK. Other parts of the UK are more monocultural but cities are generally pretty diverse.

you know, one way of making universal health care is to have a commity setting the price of medical procedures. the committee would include key stakeholders to ensure a fair price for everyone. that would leave the place for public and private insurance which would compete for prices and other features.

Flip: Saying the north is different to the south is like saying chalk is different to cheese. Both are true, but not entirely relevant to implementation of universal health services.

Actually it is quite relevant. The northern states are quite different, culturally and politically then the southern states. For instance, to begin with, in the north, people like to live in the cities, and in the south, cities are to work in, not live in.More people go to church in the south, and they’re less likely to travel then northerners. In the north, education is valued, in the south experience (in anything, including years) trumps education.

Here we have government oversight on pricing of medications. Many are set to ensure they don’t get too high. These usually only apply to common medications though.

@PGP

I see nothing in your statement that would effect how UHC would be implemented nor why anyone of a particular area would have more or less complaint over how it is implemented.

Nor do I see how it applies to other countries and their implementation of it, especially given the comments about monocultures.

Firefighters do not behave differently according to whether they’re in the city or not, and ambulances do not turn up to churches more than secular areas. Which was my point: universal healthcare is exactly that – universal.

Actually it is quite relevant. The northern states are quite different, culturally and politically then the southern states. For instance, to begin with, in the north, people like to live in the cities, and in the south, cities are to work in, not live in.More people go to church in the south, and they’re less likely to travel then northerners. In the north, education is valued, in the south experience (in anything, including years) trumps education.

flip, the price of pharmaceuticals is only subsidised by the government if they get on the PBS. To be on the PBS they must be recommended by the PBAC. The PBAC will consider the cost and efficacy of a new drug with respect to existing treatments before making a recommendation.

PGP: Your most recent stereotype of North vs South, among other breathtakingly ill-informed assumptions, completely overlooks the huge chunk of the population that lives in rural areas in the North and Midwest.

There are of course some assumptions that can be made about the political and cultural differences between North and South but you seem to be getting your information from old Dukes of Hazzard episodes.

Your most recent stereotype of North vs South, among other breathtakingly ill-informed assumptions, completely overlooks the huge chunk of the population that lives in rural areas in the North and Midwest.

It’s really flabbergasting, as though the question “I wonder whether there might be a big pile of data on travel behavior a few keystrokes away” never even bubbled to the surface. Or the question “What does this assertion have to do with the point I imagine myself to be trying to establish in the first place?”

I grew up in Detroit. I now live in a village of 850 people. There are more cows in this township than humans and that is not hyperbole.

Our little town has everything in common with the rural Southeast where I was stationed for five years, and nothing in common with Chicago (except of course for our stupendous track record in governors. Three of the last five are in jail).

Canada a monoculture?
Let’s see, one quarter of the population speaks French as their first language and periodically flirts with forming a separate nation. Big Asian- ancestry and immigrant population in BC and southern Ontario. Large aboriginal population in Saskatchewan and the Territories, with the Territory of Nunavut being predominatly aboriginal. Also Newfoundland, a colony of the UK until 1949 with a distinct culture and dialect.
As a born-and-bred British Columbian, I lived in Ontario for a year and felt out of place the whole time. I was glad to come back.
Incidentally, our health-care system has its problems, but on the whole it works very well.

Here’s where language can be used to precisely illustrate our beliefs about other groups of people:
as kids become adolescents, they begin to use more qualifers in speech rather than simple dichotomies- e.g. conservatives are MORE LIKELY to believe that small government is best; people who live in cities are MORE LIKELY to be accepting of diversity et al. Notice I didn’t say ALL.

So if you look at statements like these that have political/social ramifications, you might be able to find polls that illustrate the relationships between groups and ideas. Correlations can run from 0 to 1 ( + or -) and percentages can run from 0% to 100%. We can quantify this. Numbers change how we understand material.

Some of our friend Pgp’s beliefs may be somewhat accurate.. we can check these out. If we use language more carefully, it’s easier to express what we really mean and what we find in the real world that serves as evidence for our beliefs – all debatable, of course.

When you read a study about people’s attitudes or political beliefs, it usually isn’t cut-and-dry, although there may be trends. Stereoptypes serve as a shortcut to make judgments about how another person might feel but may be based on over-generalisations- thus they work against you at least part of the time.

Suppose my previous example about city dwellers’ attitudes toward diversity was based on a set of polls that showed 60% of city dwellers were more tolerant ( based on a specific questionaire) vs only 40% of non-city dwellers: that would definitely tell us that the two groups are different generally but it certainly leaves out a whole lot of people.

The point is that universal healthcare in the US will always be a pipedream because there is no real US culture. There are many many US subcultures, but none of them could or would ever agree on whether anything ‘universal’ is a good idea. Like, take public education. In theory, each state agrees it’s a good idea. However, many states underfund it and are willing to rob or undermine the education system at any opportunity. I suspect we’d see much the same with universal health insurance.

The point is that universal healthcare in the US will always be a pipedream because there is no real US culture.

You are once again invited to address the list of counterexamples to your “argument.”

Like, take public education. In theory, each state agrees it’s a good idea. However, many states underfund it and are willing to rob or undermine the education system at any opportunity. I suspect we’d see much the same with universal health insurance.

There is no real culture in Australia, yet there is universal health care. Why then should the absence of culture be a barrier to universal healthcare?

When universal health care was introduced to Australia in 1974 (it started operation in 1975) a lot of people were opposed to it, including many doctors and several state governments. All it took was the Federal Government to introduce universal health care.

By the time the government changed in late 1975 to one that was ideologically opposed to universal health care, they were unable to do more than tinker with the system because of its popularity with the public.

The point is that universal healthcare in the US will always be a pipedream because there is no real US culture. There are many many US subcultures, but none of them could or would ever agree on whether anything ‘universal’ is a good idea.

Yeah because no *other* country in the world has that problem. /end sarcasm

I reiterate: you have anything other than strange stereotypes?

@ChrisP

There’s no real culture here? Hmmm… that must come as a surprise to my artist colleagues. 😉

No matter how right wing the right-wingers get here, absolutely no one would win a sit in politics if they were to state they’d get rid of UHC.

I suggest that your friends are thinking of an Aussie stereotype though. I live in what’s usually considered the cultural hub of Australia. We have plenty of culture, and plenty of people enjoy both sports and arts. And, as I keep trying to point out: a hugely diverse population made up of immigrants, from Europe to Asia and others.

It’s important to remember that stereotyping works like semantic memory works- e.g. when you think of what a dog is, you imagine some type of generic creature of a particular size, that has fur and barks- a dog ‘prototype or ‘average’- not all dogs are that size, have fur or bark. Some of the research in this area sounds like an updated philosophy course… ideas, images, concepts, categories

So we have convenient sterotypes/prototypes about groups of people: in actuality, cultures are diverse and fall along salient dimensions like *urban/ rural*. City dwellers have something in common; there is also a dimension that involves higher education, another about business culture. Most of us @ RI live in English-speaking areas or speak English. These dimensions interact and overlap.

Australia has large modern cities with ethnic subcultures. And UNIVERSITIES..The outback is very large but very sparsely populated. People may form their ideas about other cultures from pop culture and movies.

Not that beer and football are rarities.Beer and football are ALL over-btw.

I think PGP is talking of mono vs polyculture, rather than the presence or absence of culture in the sense of arts etc..

There are many many US subcultures, but none of them could or would ever agree on whether anything ‘universal’ is a good idea.

At one time most Americans agreed that the Constitution was a good idea. You already have universal Federal laws that (almost) everyone still agrees are a good idea. If you can agree that laws against murder, theft etc. etc. are a universally good idea, why is it impossible to agree that some sort of UHC is?

I agree – but the point I’m trying to make is that the diversity of immigrants, viewpoints, religion, etc here is enough to create diversity in a range of ways culturally, politically, etc. We’re no different to the US, and yet UHC works here despite differing viewpoints, approaches to medicine (ie. SBM or woo), small/large government arguments, etc.

I just use the arts as an example because I’m involved in it and know just how ridiculously diverse our culture is from that point of view.

@DW

Likewise I agree that stereotypes are instinctively used by us. However, we also know that stereotypes are often wrong and used as an excuse for racism, sexism, etc and an unwillingness to look further. We can acknowledge this but it seems PGP wants to ignore the fact that their stereotypes are not only wrong, but irrelevant to the implementation of a health care system. — As I keep pointing out, even if you hate the idea of using public health care, you can still get yourself private assistance. In fact, I’ve used both. If you don’t want it, don’t use it. If you need it, you can – that’s the whole point of UHC.

I think PGP is talking of mono vs polyculture, rather than the presence or absence of culture in the sense of arts etc..
“There are many many US subcultures, but none of them could or would ever agree on whether anything ‘universal’ is a good idea.”

A comparison could be made with Europe, which is not sufficiently integrated into a single economy to sustain a single EU-wide health-care system. It may be that the regional economies within the US are more what PGP is getting at than the regional sub-cultures.

But we come back to Canada as the counter-example; surely the differences (both culturally and economic) between Alberta and Quebec and Nova Scotia — not to mention the Territories! — are wider than anything in the US.

Are there any polls showing virulent opposition to UHC within particular US regions? Seems to me (as an ignorant outsider) that all the opposition and the financial lobbying of politicians are coming from vested interests who are doing so well out of the current dysfunctional system.

I’ve found that sometimes data helps people to understand diversity and can help undermine stereotyping or using shorthand over-generalisations.
Bizarrely enough, people often stereotype themselves as being a certain type of person or having a particular lack of ability, shutting the doors on many potentially rewarding experiences and friendships.

Bizarrely enough, people often stereotype themselves as being a certain type of person or having a particular lack of ability, shutting the doors on many potentially rewarding experiences and friendships.

I continue to stereotype myself as “Someone who doesn’t enjoy folk-dancing”.

I suspect there’s usually a bit of misdirection going on with issues like this. If you don’t want people looking too closely at an issue, couch it in emotive language, and frame it in ways that divide people. For example, call it “socialized medicine” instead of “universal health care”.

I would like to know how much money health insurers are making out of the current system? We are told that Americans pay more per capita than anyone else for, on average, lower quality health care. Since I think I’m right in stating that most US health insurers are not-for-profit organizations, perhaps the relevant question is, where on earth is all that money going? Cui bono?

You already have universal Federal laws that (almost) everyone still agrees are a good idea. If you can agree that laws against murder, theft etc. etc. are a universally good idea, why is it impossible to agree that some sort of UHC is?

Your comment causes me to wonder if we both perhaps relish N. African, Middle Eastern and S. Asian culture because we don’t enjoy seeing big, white people like ourselves dancing about and being folksy. ( In foreign cultures, you don’t always know enough details to appreciate its awfulness, I suppose, only natives can).

” Since I think I’m right in stating that most US health insurers are not-for-profit organizations, perhaps the relevant question is, where on earth is all that money going? Cui bono?

But they are no longer not-for-profit organizations. For the most part they are big business now. Their executives are well-compensated, receives bonuses, they are corporations that are listed on the stock exchanges…and they have to answer to their stockholders who expect nice returns (dividends) on their investments.

“Blue Cross is a name used by an association of health insurance plans throughout the United States. Its predecessor was developed by Justin Ford Kimball in 1929, while he was vice-president of Baylor University’s health care facilities in Dallas, Texas.[5] The first plan guaranteed teachers 21 days of hospital care for $6 a year, and was later extended to other employee groups in Dallas, and then nationally.[5] The American Hospital Association (AHA) adopted the Blue Cross symbol in 1939 as the emblem for plans meeting certain standards. In 1960 the AHA commission was superseded by the Blue Cross Association. Affiliation with the AHA was severed in 1972.

The Blue Shield concept was developed at the beginning of the 20th century by employers in lumber and mining camps of the Pacific Northwest to provide medical care by paying monthly fees to medical service bureaus composed of groups of physicians.[6] The first official Blue Shield Plan was founded in California in 1939. In 1948 the symbol was informally adopted by nine plans called the Associated Medical Care Plan, and was later renamed the National Association of Blue Shield Plans.

In 1982 Blue Shield merged with The Blue Cross Association to form the Blue Cross and Blue Shield Association.[7]

Prior to the Tax Reform Act of 1986, organizations administering Blue Cross Blue Shield were tax exempt under 501(c)(4) as social welfare plans. However, the Tax Reform Act of 1986 revoked that exemption because the plans sold commercial-type insurance. They became 501(m) organizations, subject to federal taxation but entitled to “special tax benefits”[8] under IRC 833.[9] In 1994, the Blue Cross Blue Shield Association changed to allow its licensees to be for-profit corporations.[4] Some plans[specify] are still considered not-for-profit at the state level.”

Here’s Wellpoint, which is just one of many the Blue Cross/Blue Shield affiliates that are now “for-profit” corporations.

Indeed, like calling universal health care a moral imperative or human right, perhaps? Or saying it’s immoral not to provide “affordable” health care? Or saying that not providing universal health care is “barbaric”?

I take your point, but you could argue that those are simply opinions. That’s not quite the same as inventing a term like “socialized medicine” simply because a lot of people will associate it with socialism and will oppose it in a knee-jerk reaction, which is what appears to have happened.

Narad,

These examples are not federal laws.

In that case I have been misinformed and now I am confused. Aren’t there federal laws against homicide and theft? I know individual states have their own laws but I thought federal law overruled them, as it appears to in the case of medical marijuana, or is it more complicated than that?

lilady,
I was looking through the Blue Cross Blue Shield Association financial reports earlier, after I asked my wife for the name of a large US health insurer and she suggested them. I found it hard to believe Wikipedia when it says their revenue in 2008 was only $320.5 million, or about $3 per person they insured, but maybe that’s just the association and not their members. I got bogged down in incomprehensible financial jargon and gave up.

It would be interesting to know how much money goes to insurers in total, including employees, non-profit or not. It’s like the amount of money paid to managers in the UK NHS, which many people suggest is unnecessarily spent on bureaucracy instead of front line health care.

If an efficient UHC system could be built from scratch, I’m sure everyone would pay less, but unfortunately that’s not really practical in the real world, and politicians end up tinkering with the huge existing bureaucracies.

One could also argue that socialism is merely a label (indeed, one that some people are proud of) for a philosophy that says that people who earn money should contribute to the welfare of those who don’t.

My thesis (if it may be called such) is that such terms are used for two purposes:
1. to demonstrate strong feeling; and
2. to demonize or denigrate those who argue against you.
If one is to counter the statement that “it is criminal” to have people in society who cannot afford some specified level of health treatment then one must first distance ones self from being a criminal. Same with “it’s barbaric” or “it’s immoral”. Even then, the maker of the original statement is able to fall back and say, “well, you’re just barbaric/criminal/immoral/selfish/et. c.” to any who would argue the contrary position.

This is why I ask “Says who?” and “what’s your evidence for that?” and in extreme cases “Check your data!”. Well, I more state “check your data” than ask.

In that case I have been misinformed and now I am confused. Aren’t there federal laws against homicide and theft? I know individual states have their own laws but I thought federal law overruled them, as it appears to in the case of medical marijuana, or is it more complicated than that?

There are (well, for murder at least), but they’re very narrowly tailored to the purview of the federal government. There is no federal preemption in the sense of drug laws.

Narad – I’m not dancing around anything. I’m trying to understand why people are placing such a moral imperative on government provided health care as opposed to other vital services that might be provided by the government. I have not expressed an opinion of my own about whether or not government supplied health care is desirable or undesirable.

My apologies for my previous statement. In light of your most recent message, I’d like to amend that to ask: what’s so noble about saying “I don’t have anything so you owe me”?

I’d like to amend that to ask: what’s so noble about saying “I don’t have anything so you owe me”?

I’ve said no such thing. I supported a single-payer system when I had insurance, and I continue to do so. I certainly don’t expect that any such thing is going to occur, and I know people who have been in far more dire need of health care than I am.

I’m trying to understand why people are placing such a moral imperative on government provided health care as opposed to other vital services that might be provided by the government.

Do you imagine this to be a continuum or merely a bucket in which everything that might be on the table is equally worthy of attention?

I believe it to be a continuum. i believe it is possible to reasonably disagree where on that continuum it is imperative that government provide services, but that there has to be a line. Of course, once you’ve picked that line, then one may reasonably say that everything on one side is in the bucket and everything on the other side is out. So maybe I believe in a bucket. Or is that beyond the pail?

I don’t understand why health care must fall on the “government must provide this” side of the line.

And my apologies (again) if I attributed arguments to you that you did not express. On the other hand, your paraphrase of the Pink Floyd song “Money” (“I’m all right, Jack, keep your hands off of my stack.”) suggested you were doing the same to me…

Tonight, I requested a package of information about private health insurance which is just starting to be offered to resident of Canada. Now if such insurance plans become more popular, it will forces them to react to the increasing number of private doctor who may likely charge for higher premium (there was a few recent events in, IIRC, 2008-2009 where doctors where in negociation with the Quebec’s government regarding salaries).

This is the reason I stand behind a commitee of key stakeholders setting the price of medical procedure regardless if it come from the private or the public sector. This will enable sane competition between the insurers.

Because I’m in an argumentative mood tonight, would you also suggest a committee of key stakeholders to determine the price of automobiles, butter, or audio downloads? What criteria are they to use, and why are these more desirable than an open market approach?

I’m not knowledgeable enough about the free market to weight in except the lexus doctor will likely offer better care compared to the toyota doctor and insurance will likely charge me a higher premium for going to the lexus doctor.

Incidentally, I’m in Montreal tonight because I have an appointment with my primary care doctor this afternoon and under the current regime, I get to see her for a 15 minutes med check and not much more than that but given the occasion, I’d like to have some more time with her but I have to weight that with my ability to pay.

Many of us Democrats and Liberals, wanted a National Health Care System (a.k.a. “Medicare” for everyone)…we have *settled* for the Affordable Care Act.

Along with that National Health Care System, there *should be* meaningful tort reform…which is doable if the costs of future lifelong medical care is covered under a National Health Care System.

One other thing. Could we stop calling it *government-provided* health care? It’s our income taxes and payroll deductions that pay for Medicare Part A (only). Medicare recipients pay for Parts B (according to their adjusted gross income) and pay for Part D (drug coverage).

Regarding Wakefield appeal today, is there some new document that I should read (there was supposed to be something today).

They usually don’t update the status until the day after at the earliest, so it’s unknown whether the court reporters made their deadline last I checked. There probably wouldn’t be anything to read anyway; it just starts the next clock (to the 30-day deadline for Wakefield’s appeal brief).

There are many many US subcultures, but none of them could or would ever agree on whether anything ‘universal’ is a good idea

Thinking of this, the best and simplest rebuttal is: people disagree everywhere about everything. Yet we still manage fine with democratic governments, large federal and state services, and commitment to a justic system that enforces laws that affect everyone.

Saying the US can’t agree and therefore UHC won’t work is pretty much special pleading.

@DW

Yes, as always education is the magic bullet

I stereotype myself into all sorts of categories. Mostly not good ones. And I also hate folk dancing 😉

@MOB

Has it ever occurred to you that some people through no fault of their own, can’t afford many services that would actually make their life better – and therefore actually enable them to earn money and *get off* the government services faster/stop requiring so much from charities?

I think the idea of barbarism comes from the ‘veil of ignorance’ argument. Pretend you’ve got two babies, one born to a rich family and one to a poor family. Why does the baby of the poor family have to suffer more hardship simply because their parents can’t afford medical bills?

It’s the same reason we all pay for roads and why we all pay for schools and we all pay for police, etc etc. In general these services on average raise the quality and quantity of citizens/employees.

Having said that I do agree that the emotional language gets used by all and I hope I have avoided using it.

I’m trying to understand why people are placing such a moral imperative on government provided health care as opposed to other vital services that might be provided by the government.

You’ve just set up a false dichotomy. And a strawman.

what’s so noble about saying “I don’t have anything so you owe me”?

It’s not noble. As someone who is currently requiring financial assistance, because my health is so bad, I can tell you I wake up every day hating it, knowing it lowers my self esteem, hating asking for handouts and knowing even more that without it I will not be able to function. I don’t think anyone owes me. I do on the other hand feel extremely grateful.

This is no different than asking your friends for help in a time of need – and wishing fervently to get back on your feet fast so you can repay it. I’d gladly pay for 100 people’s health bills if it means that mine are covered once when I can’t afford it. As someone pointed out above, you pay into the scheme hoping you don’t need it, but knowing it’s there if you do; and this is different from private insurance how?

Oops, there’s that emotional language. I think at this point I should state: I’m biased 😉

Emotive/moralistic language or not, it doesn’t seem right to me that someone in the health care industry can be paid $13.3 million when so many people are suffering because of a lack of basic medical care. There are many things in the world that seem wrong, but in many cases the solutions are impractical for one reason or another. In the case of US health care, as Orac concluded above, it seems likely that “providing health insurance to as many people as possible is associated with better health outcomes and that lack of insurance is associated with poorer health outcomes”. There are several examples of practical and effective solutions to this problem in the form of countries with UHC. It’s the reluctance of some to adopt any of these solutions that upsets and angers me.

If Mitt Romney had a different solution to the problem, I might feel differently, but he apparently doesn’t even recognize there is a problem, as he promised in the third presidential debate that the first thing he will if he is elected President is to scrap Obamacare. It seems to me that Romney will make the problem worse. That’s why I find it hard to avoid emotive language in this area; these are decisions that have serious and life-changing effects on people, including some of my family.

I also like “beyond the pail”.. lots.
( I should note that a ‘descendant’ of the ‘Great Uniter’ has managed to sow disunity amongst us… not really)

About emotional speech, we all know how lawyers used it in the case of eyewitness testimony- ” How fast was the car going when it SMASHED into the other car?” ( E. Loftus) It affects how you remember as no one has a videotape-like memory to playback.

But also in a relatively wealthy society, people might choose to live in a way that eliminates grinding poverty and thus, be willing to pay for assistance to those who aren’t doing as well. Is that more moral? I don’t know, it might be a way to make themselves feel better and live perhaps in a more stable society. Perhaps providing social services and stipends stoke up a sluggish economy and might even lead to increased profits in particular sectors.

It seems disingenuous to slam a Romney quote and not consider whatever the Romney Healthcare Plan for the Nation (or whatever the hell he calls it), but that is about par for the course when ORAC slips into political discussions. Sadly you begin to resemble the hawkers of medical woo when you venture into political woo. You diss the studies that don’t support your position and promote the ones that do.

I am also surprised that in my attempts to skim this very long post AND thread, I see nothing about the current “safety net” of medical treatment for the uninsured and underinsured.

I was a privately practicing Medical Oncologist for 17 years and yet I made certain to know about and interface with my communities. I worked with the local Red Cross medical access programs and the County Health Centers even then. I shucked off the Oncology mantle and have been practicing Internal Medicine in the military, , VA and in Federally Qualified Health Centers (FQHCs) since. So I have a broad perspective of health care delivery from personal experience over 36 years of practice. FQHC’s provide access and quality care for un-insured and underinsured as well as those who otherwise have limited health care access (rural and isolated settings). You’ve got plenty in your neck of the woods, ORAC. I don’t see any mention of them or their history in your epistle.

You might choose to forget that this program was quadrupled under the administration of GWB.

The BO administration has increased spending, but proportionally not as much, and with a whole new set of strings. If people are dying because they CAN’T get care it might be because the health centers are forced to convert to EMR’s that are not fully developed AND decrease their productivity, and divert administrative and provider time and effort to meeting “Meaningful Use” and “Primary Care Medical Home” projects. These great sounding in theory but a nightmare for administrators and providers programs are diverting energy and money away from health care delivery in the short term. They may have some great long term benefits, but that remains to be seen.

As far as most of my patients without insurance go, the major barriers they have to receiving good medical care are their attitudes, culture and lifestyle. Most of the fact checking for what the Obama Campaign has put out there as sob stories about uninsured patients have shown them to be disingenuous if not blatant lies. That’s not to say there are hard case stories out there, but there will be in any system of care you devise. From my perspective, on the front lines, for every one patient without insurance who is working hard, and trying to make something of themselves, I see 5 whose main goal in life is to find a way to qualify for disability and ride the gravy train for the rest of their life. The main complaint I hear from these 80% is that their last SSI hearing did not find them disabled.

As far as most of my patients without insurance go, the major barriers they have to receiving good medical care are their attitudes, culture and lifestyle.

Evidence needed.

Most of the fact checking for what the Obama Campaign has put out there as sob stories about uninsured patients have shown them to be disingenuous if not blatant lies.,

Evidence from a third party source not connected with partisan political parties or movements needed.

That’s not to say there are hard case stories out there, but there will be in any system of care you devise.

Citation needed.

From my perspective, on the front lines, for every one patient without insurance who is working hard, and trying to make something of themselves, I see 5 whose main goal in life is to find a way to qualify for disability and ride the gravy train for the rest of their life. The main complaint I hear from these 80% is that their last SSI hearing did not find them disabled.

And I think that this about says it all about “your perspective.” Of course, one of the lessons of SBM is that a single practitioner’s personal experience can very easily be profoundly misleading. It’s true about whether a given treatment will work or not. It’s true about, for instance, Dr. Jay Gordon’s antivaccine views, in which he accepts his 30 years of “personal clinical experience” above objective scientific studies to support his fervent belief that vaccines cause autism, asthma, and a variety of chronic health problems. And it’s true about making conclusions like the ones you’ve just asserted to be true. Your argument, at its heart, is no different from Dr. Jay’s when bases his belief that vaccines cause autism solely on his own experience as a pediatrician.

I think this post discusses how being “on the ground” can lead to a deceiving impression:

I’m calling bullsh*t on epador’s remarks. See my comments up thread (October 24 th), about my experiences working as a public health nurse/clinician in seven satellite public health clinics, within my County’s department of health…

“I worked as a public health nurse. I worked, and I still reside in a County, which has diverse populations . We cared for people in our seven satellite clinics who were uninsured, underinsured, on Medicaid and who were undocumented immigrants. I felt then, and still feel, that we provided a medical home for these patients. Many of the patients came to us for aftercare after they had been treated in our County hospital. No one was ever turned away.

Isn’t it a good thing, that our County hospital and County public health clinics provided preventive health care and ongoing health care for pregnant women, young babies and older people, who were uninsured? Isn’t it far better to provide immunizations and to treat emerging health problems, in their early stages, instead of hospitalizing people for advanced cancers, diabetes, and cardiac problems?

Why should little kids be put at risk for vaccine-preventable diseases and for untreated asthma, because their parents are uninsured?

Why should little kids be put at risk for vaccine-preventable diseases and for untreated asthma, because their parents are uninsured?

What about the *silent killers* (elevated blood glucose levels, hypertension and hyperlipidemia) that go undiagnosed and untreated due to lack of insurance? Do we as a society want people to go into major organ failure or lose their eyesight due to undiagnosed and untreated glaucoma, because they lack insurance?

I have familial hypercholesterolemia, and because I had medical insurance my condition was monitored…but untreatable. I was enrolled in one of the early Lipitor trials by my private physician. When the trial was unblinded, my cholesterol level was 180 mg/dl…down from 400 mg/dl. What would my health status be today, if I didn’t have insurance coverage?

I’ve had medical coverage for my entire life and eternally grateful that I was able to provide that coverage for my children. I was able to afford the extraordinary costs associated with my disabled son’s medical care, that were not covered by my medical insurance. I also have great empathy for those who are uninsured and underinsured, because I know only too well the devastating consequences of not having coverage for preventive care…for diagnosing of diseases and disorders in their early stages…before they become life-threatening/incurable.”

Why don’t you tell us what the impact of Obamacare is for people who have pre-existing conditions, epador?

Why don’t you tell us what the impact of Obamacare is for people who lose their private medical insurance, through the loss of their jobs, epador?

How about discussing the “lifelong” caps on coverage for someone with a chronic or an acute serious illness, which are now removed, under Obamacare, epador?

What are these “forced interventions/vaccines” of universal healthcare that Jen is going on about? I live in the UK, and have only ever had NHS treatment. All vaccines are voluntary. Some (TB, rubella) are given in schools, but a parental permission sliip must be signed – mine wasn’t because I was needle-phobic at the time, no problem. There is no vaccine requirement to attend state schools, as I understand there is in some areas of the US. Forced interventions/treatments? The only people who can be forced to have any treatment are patients with severe mental illness, or children who are not Gillick competent. I rather doubt that no 5-year olds are ever given medicine against their will in the US, and no people with severe paranoid schizophrenia admitted to hospital against their will. And then there’s the US case of Samantha Burton – if Jen’s relatives are afraid of forced intervention then they need to be told it is already there.

I rather doubt that no 5-year olds are ever given medicine against their will in the US, and no people with severe paranoid schizophrenia admitted to hospital against their will.

I will risk veering off-topic, but it’s actually extremely difficult to achieve “involuntary” status in the current U.S. inpatient psychiatric model. (This is instantiated on the state level, but I think it’s fairly uniform.) The “informal” status that came about in the ’70s has effectively ceased to exist, leaving “voluntary” and “involuntary.” The former category carries some legal burden for the hospital on the off chance that someone who is chemically restrained and has limited phone access is going to wind up with a lawyer, but it implies assumption of the debt involved. Plus, they really want to get rid you as well. The “involuntary” category is where one has to go to court more or less to start with, and means state hospital, or “The Snake Pit,” to recollect the lurid film.

What this means, in practice, is that care is not exactly provided well. The notion that mass “forced treatments” are anywhere in the vicinity of the real world is laughable.

(To tie that back in some fashion, I think the “informal admission” model was quite laudable. Inpatient psych, however, does not seem to be a money-making operation. I don’t know how it could really be effected without a single-payer system, and I don’t know that it could be even then. Still, the way things operate in the present is to let matters get so bad that they simply can’t be ignored any more.)

Ninevah, if you bothered to read some of my other posts, I (Canadian) am not concerned in the least about UHC. We have medical care (unencumbered by insurers) that works very well overall in Canada. As to vaccinations, we seem to be quite similar to Britain where they are basically voluntary as well. Kids can attend schools no problem if not vaccinated. We don’t do hep b at birth, similar to Britain. I sometimes wonder if that has just pushed things too far for parents in the US.- just a thought. Please don’t respond again stating that I am concerned about forced interventions. I. am. Not. It seems as though some Americans feel differently- although MI Dawn says it’s no biggie if you don’t want statins or vaccines, for example. I still think insurers add to the cost of care and 13 million is obsene

Ninevah, if you bothered to read some of my other posts, I (Canadian) am not concerned in the least about UHC. We have medical care (unencumbered by insurers) that works very well overall in Canada. As to vaccinations, we seem to be quite similar to Britain where they are basically voluntary as well. Kids can attend schools no problem if not vaccinated. We don’t do hep b at birth, similar to Britain. I sometimes wonder* if *that has just pushed things too far for parents in the US.- just a thought. Please don’t respond again stating that I am concerned about forced interventions. I. am. Not. It seems as though some Americans feel differently- although MI Dawn says it’s no biggie if you don’t want statins or vaccines, for example. I still think insurers add to the cost of care and 13 million payed to anyone in the healthcare industry is sick.

It seems as though some Americans feel differently, based on this story I attribute to random acquaintances my snowbird in-laws that I just thought I’d bring up and defend for a while but now find inconvenient, although I’ll go ahead and mention it another time.

Ninevah brought it up again, not me and mischaracterized my relatives as being afraid of forced medical treatments – they’re not – they are Canadian- their American friends (some) feel differently. LIlady and Narad, you sound bitter that some in US might fight UHC based on fears of having to follow certain medical protocols as part of the package- I think it was a legitimate point to bring up given the topic – if you don’t think so then that’s your problem. You remind me of kids who don’t want to hear some things just because you don’t like/agree with them.Try and have a nice day, though I doubt that’s possible- you both sound hopelessly miserable. MI Dawn – do you think insurers should be involved in primary healthcare? I don’t. Ta-ta.

Lilady, since you think it’s so outrageous/ implausible that some people would be afraid of forced medical procedures in terms of UHC or any healthcare in the US for that matter then what would you call vaccination of newborn infants with hep b vaccine when parents have not signed consent for it or declined it, but see on medical records later that it was given?? (or even worse, threatened with CPS and having their baby taken away because they don’t want to have the neonate vaccinated with hep b ) Is that a) a medical ”mistake” the nurse made or b) veering into forced medical intervention territory? Or is anyone that says this has happened lying (I’ll help you out here- that’s highly unlikely).

you sound bitter that some in US might fight UHC based on fears of having to follow certain medical protocols as part of the package- I think it was a legitimate point to bring up given the topic – if you don’t think so then that’s your problem

You haven’t demonstrated your assertion in any meaningful fashion. It’s merely a peg for you to hang antivax tinfoil-hattery on.

Lilady, it doesn’t show up in the affordable health care act (nor should it) but some people (rightly or wrongly) worry about it in the US. O.K. Narad, this concern doesn’t exist because you don’t want it to. I don’t know but maybe there is a poll somewhere that discusses concerns some Americans have about UHC. In Canada we find it works fine, more or less.
@Lilady – you avoided my question as to unwanted hep b vacc to neonates- medical mistake (without consent) or forced intervention?

Narad, just saw a Wiki article- Public Opinion on Healthcare Reforms and a recent poll puts 45% of people concerned that government would decide on healthcare for elderly (a general concern) I am sure there are more specific polls re. Americans’ concerns (rightly or wrongly) about UHC. That would be a peg, buddy.

@Jen – I’m always confused by people have issues with “other people deciding their care” because right now, insurance companies have way more control over treatment decisions than the government ever would (especially since the Affordable Care Act is only about providing Health Insurance to Everyone – not dictating treatments).

If you don’t have an issue in Canada, we certainly won’t have one here – unless, I guess, they try to make Tylenol mandatory, right Jen?

O.K. Narad, this concern doesn’t exist because you don’t want it to. I don’t know but maybe there is a poll somewhere that discusses concerns some Americans have about UHC.

So, the idea is that you just assert it (and it was “many Americans,” remember), in the process tossing in vaccinations and the completely inexplicable “forced statins,” and now you’re down to “maybe there’s a poll somewhere,” all the while maintaining that I’m failing to face The Truth?

Lilady, it doesn’t show up in the affordable health care act (nor should it) but some people (rightly or wrongly) worry about it in the US.

Thank you for calling attention to the fact people sometines are afraid of things that don’t exist.. But we’re aware of this already, as this particular false concern is analogous to the ubiquitous false concern that vaccines are associated with autism, where similarly, despite the fact that no evidence has’shown up’ (i.e., been found) to establish any such association many people ‘rightly or wrongly’ (and wrongly, as it turns out) worry one exists.

@Lilady, ” you’re blabbering.” Well you are dodging/ avoiding. In the above case, where a nurse /doc administers hep b to a neonate without parental consent it would either be a mistake or a forced medical intervention, wouldn’t it? Oh but you don’t want to answer that. Laugh about Tylenol/ penicillins all you want. Pathetic.

Hi, Jen. Actually, believe me, a signed consent IS required for the Hep B vaccine for the neonate in the hospital (at least, when I worked there). Any parent who says they didn’t know it was given is either forgetful or lying. In fact, though it’s been many years, I had to sign a consent for all the vaccines my children got (or they did, once they were old enough), and I got the information page with the vaccine, the risks, the benefits, side effects to watch out for, etc. I used private doctors and clinics and both treated vaccines the same way. I don’t know who your friends and inlaws talk to, but at least in my experience as a US citizen, I’ve never gotten a vaccine without giving consent.

Oh – and parents are told about all shots (Hep B, Vitamin K) the baby is given in the nursery, as well as the eye drops. And they may decline any/all interventions as long as a release is signed, at least at the numerous hospitals I have worked in. And that includes all levels of society.

And at the moment, I don’t know of ANY health insurance where people pay more for refusing vaccines, statins, etc. I do know of some groups (NOT the insurer, but the group buying the insurance) that put higher premiums on members who smoke, are overweight and don’t exercise, etc. But that has nothing to do with Obamacare. That’s been going on for at least 7 years that I know of. S

Oh, and to answer your question: a vaccine – or ANY medication given without parental consent would be a medication error. The parent(s) would be told, an incident report filled out, and, depending on the severity of the incident, the nurse might be disciplined or terminated. Nursery nurses are not just randomly injecting any and all infants with vaccines.

I recall one instance, related to me by an I.D. doctor at a local birthing hospital, where a mother attempted a home birth and then went to the hospital for delivery. She *might* have been attended by an amateur midwife or a nurse-midwife, who had failed to order a maternal hepatitis B surface antigen test during the pregnancy.

Consequently, IIRC, when the mother balked at having her child immunized with the hepatitis B vaccine, and, in the absence of a maternal blood test result to determine the mother’s hepatitis B carrier status, hospital staff was quite insistent that the infant should receive the hepatitis B birth dose, before the infant was released by the hospital. When the situation was explained to the mother, she agreed to have her infant immunized with the birth dose of hepatitis B vaccine.

Every State has department of health regulations in place that require OBs and nurse-midwifes to test expectant mothers for the presence of hepatitis B surface antigen. Every State has department of health regulations in place that require a copy of the maternal hepatitis B surface antigen laboratory test result to be sent to the birthing hospital, prior to the EDC.